Forever the crucifix!

21 June 19

It is tempting to state that today bearing the cross of the medical profession must seem like a curse to most of them! The pressure from public levers is always on doctors, to provide affordable care, to provide doorstep care, to provide rural care, to provide in house care, to provide personal care, and any and every ailment surrounding the medical architecture is squarely blamed on the doctor who is available at that moment!
The modern doctor is actually unaware of the hagiography that surrounds his or her chosen profession. It is a legend of many millennia, where once the forebear of the profession practised nothing more than segregation, baths, application of scented oils, and prayers for healing in complexes which were associated deeply with religious faith. The earliest druids or bishaks were faith healers. Priests. The entire medical world evolved from that unitary person, who chose to create a craft, an orderly fashion of offering succour to the diseased and dying! That is why an extraordinary amount of empathy and understanding is expected from the doctor by patients! Doctors are literally roaming around as ‘Mother Teresas’, tending to us in our suffering, they are our soothe sayers, our sounding boards and emotional crutches and so on. Such a huge psychological burden of patients on doctors was largely manageable till the time doctors did not have much to offer by way of interventions. Till about forty years back, the routine and scope of medicine was not vast, it has small branchings of its fields and these thick trunks of specialty did not tax the doctor’s itinerary through them!
While our hangover continues of the doctor and halo of the medical profession, the field has blossomed, or shall we say, grown manifold through technological inputs and pharmacology! So today while the doctor deals with ever changing pharmacopoeia, few are able to accept that drugs and drug driven therapy is no longer under the purview of the doctor. Like wise the advent of imaging has made dramatic changes to possible procedures, now plaques and blocks in arteries are actually plumbed free using guide wires, balloons and callipers to physically remove the block! Now it is possible to super cool the body, stop blood flow to portions of the brain briefly and tackle surgically arterial anomalies/aneurysms which earlier would kill us one fine day by bursting out spontaneously and which doctors used to glibly advise us was our ticking time bomb! Our heart can be stopped for significant periods of time, while the body undergoes a heart lung bypass, to repair its valves and vessels!

All these advances mean that medicine has become so complex that doctors are actually themselves following algorithms, protocols for treatment which are recommended to them by peers or scientists who are driving the increasing specialisation of interventional care. Today robot assisted surgeries are becoming the norm, tomorrow AI assisted clinical decision making will become the routine! So much has gone from the doctor being the sole and whole to now being increasingly a mute spectator to the activities that are covered under health care. What all these complexities mean is also that doctors are busier than ever, and more behind instruments and scopes and not really with us patients, holding our hands or lending their ears!
The second major disruption in health care set up has been the concept of Hospital Based Care. Earlier going to a hospital was for a bedridden condition or one that required surgery under General Anaesthesia. Now you go to a hospital because the specialist OPDs are there. When you can walk directly to a cardiologist then why speak to a GP about your gas trouble? After all, if its gas it will go away on its own, but if its heart, you need the cardiologist, right! In last three decades, India has seen how private players have taken hospitals to a whole new level, by treating hospital based care more like a hospitality industry. So the experience of air conditioned complexes, token system, TV channels to browse while you await your turn, or listen to channel music, coffee vending machines, refreshments, news papers, magazines, makes you wonder whether the modern OPD complex is meant for the sick to seek consultation or for folks to seek indoor entertainment! There are an army of receptionists, patient counsellors and more in private sector now, that you will never be at a loss for anything. And when you get your turn to consult, you forget 90% of what you wanted to ask, the consultant is waiting for you to disclose your ailments, then evidence based medicine kicks in, a battery of tests are ordered and so your time in modern hospital is spent more in this drama of the structured care, than with your consultant. Your doctor has become so far removed from you, that he/she has become impersonal.
With modern medicine driven by algorithms and battery of tests, called euphemistically as ‘defensive medicine’ the attendant cost of a ‘treatment’ is now not a simple consultation fee and the prescription paid at the pharmacy. Plus all the hospitality overheads kick in as well. Now folks rather hedge a bet on their health than spend. I have never been more amazed than this pop question and the nope answer I elicit in my interactions with random strangers- Do you have your car serviced regularly? Your Inverter? Your two wheeler? All this is affirmed with a thumping ‘Yes’! Then I slip this- Your Health check done? No. Most people feel that if they went for a health check up, something wrong will turn up, and then they will be burdened with its treatment and its worry. When body is functioning clockwork style why interfere and place it under microscope?
So with mushrooming of modern hospital care, has also come about this hedging on our health. Thanks to conspiracy theories about Big Pharma and Nexus between Doctors and Pharmacies, about cuts for investigations like CT, MRI, Xray and even Lab tests, there is suspicion in the patient fraternity which grows even unfounded because of the impersonal and distant doctor. If you know your doctor well, and have developed a relationship with him or her, you will never doubt their advise for tests or treatment. It is as simple as that. But because today we travel to hospitals where we don’t know any doctor personally, and because the gigantic structure is forbidding and impersonal, we harbour intense suspicion and speculate about the reasons for any advice before we accept them grudgingly.
That is why accept ‘Dadima ka nuks’, we are forever trying to see alternatives to modern medicine. Compare the specialist of modern medicine to a homeopath or Ayurvedacharya, and you find that they have more time for you, without even realising that modern medicine is structured by science, proved by research and standardised by clinical evidence. So a homeopath or Ayurvedacharya has leeway in approaching you, and in that rare case where you find a clinician of the old days you will find the same relaxed approach that you otherwise missed in hospital based care. Over a period of several visits, the specialist who attends you most of the time will be able to offer the same latitude that the good old GP offered too! But the risk is always there, that some thing could get missed in a purely clinical non algorithmic approach. And we patients do not have the stomach for trial and error, do we!
The worst thing to happen today is to do with pharmacological agents. A whole generation has grown that is suspicious of vaccines, antibiotics, of anti hypertensives, statins, anti glycemic and so on. We seek ‘desi ilaj’ or folk medicine, not just for exotic cancers and autoimmune diseases but also for diabetes and hypertension. We want to somehow get out from the trap of modern medicine and its prescription, because we have a trust deficit. We are informed by our best friends and colleagues how pharmacological agents are not natural substances, they are so concentrated that they are toxic to our bodies. Side effects of drugs are passed off as evidence of such toxicity. We want to be gullible and believe that some rare herb or mushroom or mixture of tree bark with dry fruits will rescue us from being enslaved by pills and tablets from the pharmacy. At times, we get so carried away, that we cause great harm to ourselves or our dear ones in the process. I know people who took alternate medicines in the form of syrups for skin ailment only to find that after a year of treatment, they developed diabetes because the syrup contained steroids! Some friends reported back ache on taking some ‘Bhasma’ or ‘potions’, which turned out to be kidney inflammation due to heavy metals present in these unsuspecting magical potions! But bad news does not get the traction, the spread of news about alternatives is always faster than the news of their inefficacy or their side effects!
Deep inside us, we all feel we are immortal. It is sort of essential armament in our psyche. It allows us to confront all the adverse situations we are confronted with and it is also the very same thing that makes us take our health so casually. We are willing to experiment with shortcuts, with alternatives to proven therapies and postpone treatments because we think we still have time. A person like late Crazy Mohan educated, erudite and an engineer who used his skill to tackle blind faith, voodoo, astrology and tantrik black magic by making comedies on them, said he never wanted to visit a hospital for the fear of finding out something was wrong! He was taken first time when he collapsed at home, and he could not be revived. What modern medicine wants to offer is a possibility that a health check up could decipher a problem and fix it, but what it cannot grant is a guarantee that what is fixed stays fixed or what is wrong will be identified. That is why even when medicine performs miraculous interventions every day, as patients and public we look for miracles elsewhere!