"I keep six honest serving men,

They have taught me all I know.

Their names are, who, why, where,

What, when and how."

Rudyard Kipling.



I do not remember why I wanted to be a doctor in the first place, but doctor I did become like any one of you and was as proud and arrogant as any one could be until, once upon a time, I was called to see a young man of thirty brought dead to our coronary care unit, in the wee hours of the morning. The most profound question that the young widow asked me, clutching my ankles, shook me from my deep slumber. "Why did my husband die, doctor?" For the first time in my life my intellectual impotence came to light. I could have given her a big lecture on how her husband died, but not why!



Charles Sherrrington, the great physiologist, was appointed professor of physiology at the University of Liverpool, at the age of 42, in the year 1899. While delivering his acceptance speech he said, "Positive sciences can not answer the question "Why". They can, at best, answer "How" or "How much", but never why! A physiologist could say how the heart contracts but would never be able to say why does the heart contract?



That took me to philosophy, religion, theology, teleology, and what have you! The one book that gave some comforting thought was the Penguin classic written in 1927 by a great American, Thronton Wilder: The Bridge on San Luis Rey. Life and death are not in our hands. Let us not take the public for a ride by claiming that we could save people from the jaws of death. This kind of self aggrandizement has now landed us in the market place with consumerism getting into this arena of doctor-patient trust; the one that kept us going from the time of God Dhanvanthari. The mutual trust is the apex of medical care. The crucial part of medicine is the coming together of two human beings, the one who is ill or imagines he is ill and the one in whom the former has confidence. This is necessary for the human immune system to get stimulated to heal the wound.



The Art of Medicine:



Listening to your patient is the most difficult part of a doctor's life. Learn to listen and you will succeed as a good doctor. Listening is the first and foremost part of the whole gamut of doctor-patient relationship. Healing is an art. The healer must master his technique just as a painter does. A good doctor should master the art of healing; never becoming so lost in the western obsession with objectivity and its emphasis on reproducibility of experimentation. The art of healing is not being taught in medical schools in India which still follow the 1857 London University Syllabus for the MBBS course in our country. The pity is that even in our own Ayurvedic system, the mother of all systems of healing, taught in our schools, we seem to have forgotten this important part of education of a doctor. We teach medical students to listen, palpate, auscultate, and scan, but forget to tech them the most important ingredient of human affairs; to feel pain, disability, and suffering of another human being. Unless a doctor learns to feel other's pain, doctor would never understand what it is to suffer from pain and how important it is for him to ease the other man's pain! Learning to feel other's pain is the main part of a doctor's education. Henry David Thoreau wrote, "To affect the quality of the day-that is the highest of arts." Medicine has the capacity to affect the quality of the day for the patient. Let us remember it for the rest of our lives. To be a good doctor is the greatest opportunity in life as it is the only way one gets exposed to human emotions in their pristine glory and virginity.



Qualities of Head and Heart:

"One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient."

Francis Weld Peabody 1881-1927.





Doctors need two special qualities of the head and heart that make them placebo doctors and therefore good healers.

!) Imperturbability:

Under no circumstances of peace or war you should get perturbed while dealing with patients. Your body language, even a frown, could kill an anxious patient.

ii) Aequanimitas:

Keep your mental cool under any trying situation, come what may. It needs a cool mind to rationally think in an emergency situation.



A good doctor could be compared "to the promontory of the sea, against which, though the waves beat continually, yet it both stands, and about it are those swelling waves stilled and quieted", as enunciated by Marcus Aurelius.



Medicine as a Business:



Medicine, riding piggyback on technology, has gone to the market place in a big way. This has destroyed medical ethics, making most of us hypocrites swearing by the Hippocratic Oath! Even research is no longer the measure of honesty and purity. There are enough and more studies showing that the so-called evidence based medicine is really evidence burdened, in favour of drug companies and technology manufacturers. Doctors are being bought over by both drug companies and instrument manufacturers to sell their wares.



Is Academic Medicine for Sale? is an editorial in a recent issue of the New England Journal of Medicine(2000; 342:1516) and Medical Education in the US is run by Drug Company Money is the caption of an editorial in The Lancet (2000; 356: 781). Cardiac procedures are done more to get money than to help the patient is the essence of an editorial in the NEJM (1997 page 1523). I have only given you a sample of the rot that has already set in. Writing a book Science without Sense (CATO institute Washington 1999) Steven Milloy shows how medical research is faked deliberately many times!



A senior teacher of medicine, Frank Davidoff, who also was the editor of the Annals of Internal Medicine for well over thirty years, laments in his book Who Has Seen A Blood Sugar (1997 ACP publications) how we try and treat the blood reports and neglect the suffering human being, the owner of the report: the latter many times suffers more by our interventions. He calls this as euboxic medicine. As long as the computer boxes are all correctly ticked, doctors do not worry about patients in defensive medicine.



All that glitters is not necessarily gold.



I shall recommend that you keep this prayer of a great clinician, Sir Robert Hutchinson, on your work table:

God, give us deliverance from:

* Not letting the well alone

* Treating human beings as cases, and

* Making our interventions worse than his disease.

How true!



You are still non-converts, I hope. Keep medical science as pure as you possibly could. Try to change the trend if you could; but remember that you would be up against the stone wall in this area.



"Fear not! Life still

Leaves human effort scope.

But, since life teems with ill,

Nurse no extravagant hope."

Mathew Arnold. Empedocles on Etna.



Money is not the criterion to judge you as a good doctor. Never try and make money in the sick room. You will get your due and, a fair share at that. Do not be in a hurry to make it big fast: no one has taken money with him while going at the end of life! The gratitude and the smile on the face of a grateful patient are priceless and give you true happiness. One must strive to earn such smiles in abundance.



Some of us will fail in life, but never lose heart. It is in losing that you win. "From our desolation only does the better life begin," advised Sir William Osler. If you can treat triumph and disaster, the two imposters, just the same, you will come on top.



Your Alma Mater:



While the West was still dwelling in the forests, we in India had Universities of excellence attracting scholars from all over the then civilized world. One such was your University. Be proud of your Alma Mater. Universities are not judged by their pride, pomp, and circumstances, nor their wealth, number of schools or halls, but by the men and women, your teachers, who have trodden in its service the thorny road through toil. Remember them all and also your Alma Mater in times of prosperity. Many foreign Universities depend on the munificence of their alumni. Do not let your University down.



Complementary Systems of Medicine:



Modern hi-tech medicine has become so prohibitively expensive that today 62% of the upper middle class Americans can not afford health insurance in that country. 57% of Britons would want to opt out of the system, if they could. While the ten percent of emergency quick-fix measures depend only modern medicine, one could do well to avoid modern medicine in non-emergency chronic illness scenario, as also in minor illness syndromes that form the bulk of health care delivery problems to make medical care available to all sufferers. Many of our quick-fix methods in emergency care, however, are still to be audited for their efficacy! (Chest 1999; 115:857)



One could practice allopathy, homeopathy, or any other pathy successfully, if only one could combine that with sympathy and empathy in good measure. Health care would be possible for the poor masses if we teach our students the significance of taking the best from all the complementary systems, in a judicious mix, keeping the touch stone of scientific methods at the centre of our choice. In this area Ayurveda, the mother of all systems of health care, stands out as the most scientific and effective. One must, however, understand that Ayurveda is not synonymous with herbal medicines. It is the science of life and living.



With quantum physics opening the eyes of the modern scientists to the beauties of the human mind (consciousness) in human illnesses, interest in Ayurveda, which has been proclaiming to the world for centuries the prime role of the mind in diseases, has been recognized as the best and the most scientific. Heisenberg's Uncertainty Principle and Schrodinger's Cat Hypothesis have endeared scientists to the holistic science of Ayurveda.



Ever since medicine was accepted as a science in the European Universities in the twelfth century, medicine relied on linear mathematics. Linear mathematics does not hold good in dynamic systems like the human body. "Doctors have been predicting the unpredictable," says William Firth, a physicist in Glasgow (BMJ 1991 26th Dec. issue). We have also been frightening people by picking out numerous risk factors like the magician pulling out pigeons from his hat. If one were to avoid all the so-called risk factors one can not possibly live on this earth. Most, if not all of them, can not predict the outcome as time evolves. All that was explicitly explained in the time-honored wisdom of Ayurveda.



Continuing Medical Education:



The Sanskrit etymological root of the word "physician" is "bheu" which means to grow . It is now time for you to unlearn what you had learnt so far for the examinations and relearn the real life medicine to do most good to most people most of the time. Let not your medical schooling come in the way of your education! Keep learning as long as you live. Human knowledge changes faster than you think. Most of us would not know what has changed under our very nose, if we do not keep in touch. One must learn from one's mistakes. It is totally wrong to believe that doctors do not and can not commit mistakes. If that were true doctors would be doing nothing. Do not get frustrated if you commit any mistake, but do take care that you never ever repeat the same mistake twice! Never sweep your the mistakes under the carpet. Grow from your mistakes. That is anubhooti.



In conclusion, I admit that all can not achieve greatness but try one must. If we aim at the sky we would certainly reach the first floor.



"Manushaanaam Sahareshu, Kashcid yathaathi Siddaye,

Yataamapi Siddaanaam Kaschin maam vetti tattvathaha."



(When thousand people try one might reach excellence, but when thousand such excellent people struggle one would reach me (top))



There are two quotations, one in the beginning and one at the end. The one in the beginning is the essence of research, and the last is the essence of patient care, nay life itself.



"I have striven all my life,

Not to HATE human action,

Not to LAUGH at human action,

Not to WEEP at human action,

But to UNDERSTAND human action.

Spinoza, the Spanish Philosopher.