DOCTORS’ DILEMMA
Posted by bmhegde on 1
“Oh! let us never, never doubt
What nobody is sure about!”
Hilaire Belloc 1870-1953
A thinking doctor will have a great dilemma in the midst of all the medical claptrap that is being sold to the gullible public. Most of what we do is not being properly audited: when audited the bench marks used are questionable. The euboxic medicine, trying to see that all the boxes in the computer generated case records are filled to avoid future litigation, practiced in the west today and, copied by others, would only keep the record sheets straight but might result in dysboxic death, death at unexpected time and place, of the patient! This is one of the reasons why the death and disability rates went down when doctors went on strike in Israel recently. This has to change and the earlier it happens the better for human kind.
Our present disease based medical education should be replaced by patient (human) oriented medical education of yore where the patient was the kingpin in the game of healing. Great brains of the past- Sir Thomas Lewis, Sir William Osler, Lord Platt, Sir George Pickering, Paul Wood, Paul Dudley White, Sam Levine, Thomas Holmes Sellers, Lord Brock, Lord Brain, John Hutchinson and many other thinkers of the past had said this time and again but we, in our present delusion with scopes and scanners, thought that we need not pay heed to these people. In fact, if one re-reads that classic by Richard Asher, Talking Sense, even today one would wonder that his writings are contemporary and very topical. They all had robust common sense which is a scarce commodity in the medical world today. Lord Platt wrote: “if you listen to your patient long enough he/she would tell you what is wrong with him/her.” Today’s technologists would think this is madness. However, a recent double blind, prospective, computerized study in London showed that listening to the patient and reading the referral letter from the family physician gave 80% of the accurate final diagnosis and one hundred per cent of the idea of future management strategies in medical out-patient diagnosis. Would not this cost a lot less?
Value based medical education, preferably in the community, would solve some of the problems, like over-investigation and over-treatment that result in many Ulysses syndromes. Rather, teaching in the hi-tech set up should be discouraged to make the doctor-patient relationship the sheet anchor of medical care delivery. Medical students should have lessons in medical humanism, which includes insight into the real health problems and their solutions. Research must be better regulated. Financial interests of the researchers needs to be carefully assessed before publishing their data. Time is now ripe for openness in research.
The profession, before advertising to the gullible public about their new feats, should evaluate newer heroic surgical procedures that bring in fame, money and status to doctors, hospitals and the manufacturers of equipment. Deportation of the neurologist under the most draconian law in South Africa, in the much publicized first heart transplant, for refusing to declare the donor brain dead, is a glaring example of what happens behind the scenes in such situations. We need stricter control over these heroic procedures where the real hero is the patient who offers himself for the procedure unaware of its implications and hazards. Interventions could be audited, like drugs, by controlled studies. Many new techniques had resulted in mortality and morbidity in the past: they are too many to enumerate! Most of them have been swept under the carpet.
Medicine revolves round anxiety-patient anxiety of disability and death and doctor anxiety of having done enough of the right thing or not. If something could be done to allay both these, we will have progressed in the right direction. Doctor’s dilemma that causes so much of stress related diseases among doctors goes unnoticed to the detriment of patients and the public. This has to be urgently addressed by the profession as also the powers-that-be. This is not a small matter. Hope sanity will prevail and medical education gets suitably modified with special stress on continued rounded professional development.
Before society loses faith in us we have to change for the better and make modern medicine accessible to the majority of the suffering humanity. The popularity of complementary systems is not to be taken lightly despite the fact that we shout from house tops day in and day out that complementary systems are not scientific, people in large numbers opt for those systems. They are not fools to do so. Let us introspect before it is too late. We should remember that a patient could live without we, doctors, but doctors can not live without patients. Before we reach that stage let us act wisely and set our house in order.
“Man’s mind stretched to a new idea never goes back to its original shape.”
Oliver Wendell Holmes