Bring some nobility back




"Two types of individuals graduate from medical school. Those who view medicine as an occupation and those who view medicine as a vocation. The former are called Doctors. The latter, Physicians. Sustaining the Dignity and Nobility of Medical Care is a cogent reminder that being a true physician requires not only service to our patients, but also to the gift of our profession..."
– Patrick J. Loehrer, Jr, MD, Melvin and Bren Simon Cancer Center





Medicine is a noble calling and it is a rare privilege to care for patients. I have always believed strongly that we, who have that privilege, also bear the responsibility for respecting the essential nobility of providing medical care. For a variety of reasons it is challenging today in what we call modern medicine to sustain that spirit of care and to put trust in the system of care.


Many of the challenges, which are as old as the practice of medicine, have to do with medical ethics and money. There is far more money at stake in the current medical marketplace than at any time in history, and companies that make products used in medical care have enormous financial and political influence, and so are hospitals too. Another challenge is the implicit belief by the public that there is a medicine to fix anything. This often leads to greater difficulty in accepting that one's medical problem cannot be cured or in facing the prospect of one's death or the death of a loved one.


It is a long and arduous journey for an aspiring medical student.. It takes close to 15 years to become a complete doctor. You have about five years of medical school, another three years of post graduate studies, then specialization and maybe few years before settling down and practicing. Youngsters today do not have the patience to wait for about 15 years. For that matter, even their family members do not have the patience. The best and the brightest are no longer expected to enter the noblest profession, the practice of medicine. People pay millions to buy admissions for their children to medical schools. With money, they make them doctors, who otherwise would be incompetent to gain admission to any University. That is a big investment. Why do they do that? The investment should bring in returns to them some way or other.

Young physicians are being told that they will find jobs in the health care industry. Health care industry is a term calculated to depersonalize the practice of medicine, and thereby de-professionalize it. Industry is defined as the manufacture or production of goods on a large scale. In contrast, the practice of medicine is a calling, a personal service delivered on the smallest possible scale, one to one. With the effort to reduce the healing professions including physicians to an industry, the terms customer and consumer are used increasingly to replace patient.
Referring to the patient as a customer in a subtle way denies the essence of the patient-doctor relationship.


Doctors now advertise in ways which, until recently, were held to be unethical and unworthy of any profession. The result has been a shift in emphasis. Caring for the patient is giving way to competing for the patient with hopes of stimulating a sale in the medical market.




I recently saw an advertisement in the local newspaper.  Even though the item was given as news, it was obviously, propaganda. The news was that” Doctors save the life of a woman”. I was amazed at this news. Doctors are supposed to save lives, and what else? So I read on.

The story was headed by a half page picture of a  lady doctor wearing the doctor’s coat, sitting with her computer and an ultrasound scan picture. A patient had an ectopic pregnancy (pregnancy outside the uterus).This patient was admitted to the hospital where this gynecologist was working. She did the ultrasound exam and could not locate the pregnancy. The radiologist repeated the ultrasound and found that the pregnancy was implanted on to the surface of the liver, which is rare. Then the general surgeon operated and removed the growth. And finally, the gynecologist is seen sitting with a great smile of ‘Eureka’. And her biography and address naturally follows the news item. In Malayalam there used to be a saying “ the man leaning on the wall took away the girl”.(Mannum Chaari Ninnavan Pennum Kondupoyi)






This is the limit to which medical profession and doctors have degraded. They resort to anything and everything to make money. Ethics are long forgotten. I only wish they get the time and peace to enjoy this kind of money. 

Present day Health insurance has given way to sky rocketing medical bills. A doctor, who charges hundred rupees usually, will give a bill for five hundred, if the insurance pays the bill. And on top of this, all unnecessary investigations are added up on and repeated to make the final bill as huge as possible. Doctors play along in this game, as they are given a cut in this.

Law and philosophy serve as effective guides for patient management, but the physician must ultimately rely on his or her own judgment, based on moral and ethics, taking the facts and values of the individual patient into account. Physicians' sensitivity, empathy, integrity and clinical expertise should merge to give them a firm sense of what constitutes effective treatment and patient satisfaction. After all, that is the purpose of the profession, isn’t it?











Comments

  1. Hello doc, Good to see a doc enraged and sad about the state of this noble profession. I have tried to discuss with a few docs the lack of ethics, integrity and abysmal knowledge and conduct of some doctors. But they were not eager or keen to engage in a conversation on the subject.
    It is well known that the doc- patient relationship is one of Merchandiser and consumer, or customer. It is in fact a bigger risk than the disease or illness itself when one goes to a doctor. You can never know until later if the guy is a capitation fee genre or a reservation beneficiary. If it was Capitation fee that propped him up well then he will be straining his energy and muscles to harvest back the money paid. Human sensibilities do not matter. And if it is a guy propped up by the mark subsidy system then quality is poorly low. His knowledge and grasp is a danger to the patient. In both ways you may lose the wrong kidney or the wrong artery.
    And the Pharmaceutical Companies are competing to net practising Docs. The gratification generally offered is family cruise on a luxury liner or a luxury sedan.
    As recently as a month or so ago, C was nearly pulled and pushed into a surgery by a gynaecologist, a surgery that was not necessary. And out of her eagerness to operate the doc prescribed some antibiotics for the common cold C had then. It was a new generation antibiotic, not the normal Penicillin or ampicillin that we take. Three capsules costing two hundred fifty. We smelt rat and went for a second opinion luckily.
    Again all-round decay! That is what I would say

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  2. YEs indeed medicine is a noble profession pity it has gone to down.. I remember one incident i had gone to india and was travelling from my vilalge to chandaigarh , saw a accident and all people there were standing and basically doing nothing.. so me and my amtes got this guy in our car drove towards the nearest city , found a doctor's practise who refused to look at the injured saying we shud take him to a bigger hospital and police

    I mean he could have given FIRST aid to the bloke

    and the news coming in media about hospitals sad situation i guess MONEY MAKES THE WORLD GO ROUND...

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  3. I know, we are seeing a decline in ethics in all professions especially doctors. Good to hear your take as a doctor about this. I am also losing faith in the doctor's assessment at times because of the costly medicines and tests they prescribe. These big hospitals are a hotbed of scams.

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  4. It reminds me of the 'settling-in of decadence' of Anil Kurup. Doctors are no exception. But I am sure there are a few take the profession as a vocation.

    A few months back I had to undergo a surgery in one of the better private hospitals in Trivandrum. One question they asked at the time of admission is that whether I have medical insurance. I didn't have, but was puzzled at the question, and later came to learn the truth!

    Like everything else in life, health care is also big business now. There is no escape from it, unless the individual doctor feels different. I wish these doctors who mint money in the private/public health care sector, allot at least a couple of weeks a year for charity work. Go to the slums or the coastal areas or the tribal hamlets deep in the forests and give those poor people a little bit of service! I know some doctors who do this, albeit the fact that it is sponsored by the Rotary or Lions' or some other club out to make a publicity mileage out of it.

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  5. @In usa ,its more of business and insurance related as uou explained ,but i notice that i if the doctor charges a 150 dollar for his visit ,then he would do justice for the mone ,i mean he would attend to all the questions and doubts of the patient ,spend 1 hr with the patient for an appointment,would also do a follow up and call the patient ,even the pateint can aceess the doctor .atleast we (pateints ) are happy.But what i noticed in india in some places is that doctors charge an awesome 500 rs and dont even give 5 minutes ,would ignore any of the questionsor doubts.sir what u have written is absolutely right.Its true we need to be ethical .Hippocrates oath is not be kept under thew wraps in books!

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  6. @ Anil
    You touched many difficult issues.The whole system of admissions to medical schools have changed.They quoted many reasons,but I am not convinced. When were were doing Pre degree course,every one at our College would know who all would get admissions to medical colleges.Only the best could get in.That was it.I was supposed to be a good student at the college which sent me to medical school,but when I reached there,I was shocked.
    Rank holders from all subjects were all crowded together.The competition was tough.Only 50% would clear the first MBBS exam among them!.My class mate, who is the dean of the faculty of medicine has always stories to tell me about student behavior.He was taken to the court once for failing a student. No one should fail.The government will decide if at all one has to!

    We had a different set of teachers.I remember with reverence and gratitude my professors Dr KV Krishna Das ,Prof.P P Joseph, Dr K N Pai, Dr TDG Pillai,Dr VC Mathew Roy and the like.They were dedicated teachers.
    Prof KVK used to say ' I am teaching you life,not only medicine".He was the only son of Mamkombu Swamikal, the Kuttanad landlord. His salary was lesser than the value of the coconut shells discarded from his rubber estate.He never used to go home for lunch.He would take a short nap at the hospital itself and continue his afternoon classes for the PG students.His teaching rounds would go to up to ten at night.In between,he would buy us vada and coffee from the Indian Coffee House.
    They set good examples for us in life and career.
    Medicine is just another business now. It has lost the one thing which was unique to it.Compassion.

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  7. Doc,What did you note, " Compassion". A doc talking about lack of compassion ???

    Docs must say, " compassion, my foot".

    Cry Cry and wail that we live in these times.

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  8. It wont be right for me to run down any profession, but Doctors must do more to remain in the respectable slot.
    I can site personal experiences, but it wont be fair.

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  9. Having my fair share of medical complaints, it was nice to hear the doctors side of things.
    As we were both mentioned on NRIGirl's site AND I love visiting other bloggers I thought I'd stop by and say hello. Nice to have met you, I've enjoyed visiting.

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  10. Major hospitals claim to deliver "Care with Compassion". Just get there with an empty pocket and you'll know just how. I for one, have had only few encounters with docs, but bad ones. Ordinary Flu treated with a heavy dose of medicines that saw me in the ICU, pregnancy with heavy bleeding and doc scares me about abortion etc. I don't think I trust them anymore. Hospitals are the last resort for me.

    And it's heartening to know that a few doctors such as you still believe in the profession being noble, about ethics and integrity. Keep the good work going. Hope the others would soon follow suit.

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  11. @Bikram,
    This is a very usual issue. The reason is because the doctor may be called later to the court as a witness.So,they avoid attending the accident cases.This is unacceptable and unethical.
    Come back again. nice to meet you.
    @ Rachna
    The same medicine is available at different prices.About 30% of medicines sold in India are fake.
    @ Balachandran
    There was compulsory service at earlier times.no more. If the practitioners had such good will,they would not do unethical practices.
    @ raji
    yes,you are right. I noticed it too. We have visiting consultants from abroad, and they are all so polite and appear dedicated.
    @ BKC. There are problems every where.But isn't this a special field?
    @ petty Witter
    Welcome. I had been to your site,and I liked it.Come back soon.
    @RGB
    As Anil said," Compassion,my foot" is the dictum.
    Sometimes illnesses take unexpected turns.I don't know what was your problem,but many a times,doctors are helpless. With all the advances,it is impossible to find the cause for all fevers.
    Thanks for the visit.Come back soon.

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  12. Last day I was waiting outside icu where my grandmother was admitted and heard someone tell that one doctor in a private hospital came off his holiday to perform angioplasty. He was supposed to be away on holiday, but didn't want to miss out his cut from that operation.

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  13. @ elizabeth
    Angioplasty has become more expensive than a by pass surgery.But the results are not comparable.Each stent would cost about 75 thousand.More money in least time.

    I see most of your book reviews.keep on writing.

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  14. This is my first visit to your blog and I really enjoyed reading your post. The profession of a doctor is a noble one. I come from a family of lawyers and doctors and I know how hard doctors work, the long hours, the commitment to patients and the dedication. However, in metro cities like Delhi or Mumbai, I find myself doubting the integrity of doctors who work in 'top hospitals' because they put patients through a very expensive rigmarole of a series of tests before they are even willing to listen to the patients. After the tests are done, a long list of very expensive medicines are given and that just rattles me off because seriously, I don't want to be considered a lifelong patient. I want to be well and on my feet at once.

    Each time you visit a doctor, the consultation fees just empties your wallet but my worry is that if healthcare becomes so expensive and difficult for professionals like me, what about the ordinary Indian? Isn't there a more effective solution to this problem?

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  15. Mixed feelings and a long post
    Similar thing happened with my husband like the one Bikramjit was saying. He took a
    bleeding man once whom he saw on the road after an accident to a nearby hospital and the doctor refused to treat the guy. He didn’t let that go easily and made that guy take proper actions and left the
    place only after the patient was fine.
    But the attitude of common people is not much different.
    Just a couple of weeks back we saw an accident in front of us and saw a car hit an
    auto rickshaw and both the guys in the auto falling out unconscious. When we went to look, the
    owner of the car was worried about the damage to his new car but did nothing to
    take the bleeding guys to the hospital. Then as usual at such a situations my
    husband decided to take both the guys to the hospital called KIMS in TVM. I was
    so surprised. Nobody asked us any questions. Nobody stopped us to fill any
    forms; they just took the injured to the emergency! I was never expecting this kind of response .I was prepared to stay there until police arrived. Anyway then we took the car owner’s wife and kid to their home as it was on our way. All she was worried about was how much they have to spend on the car!! In the evening my husband called that person and asked if he had gone to the hospital to check on them. He replied-‘One man did not suffer any serious injuries and the driver only had
    a head injury and some broken ribs, that’s all”!! He said his relatives took him
    somewhere else from that hospital! This cold behavior shocked us. ‘Only a head
    injury and broke ribs!!’
    The difference I felt in the US and India when it comes to Doctors is the personal relation we have with
    the doctors in India. We are still going to a hospital 45 minutes away even though there are good hospitals nearby, just because of the relation we have with the doctors there. We are going there for the past 20 years. In the US the doctors are willing to spend hours answering our
    questions calmly and that is a wonderful thing. They never laugh at you for your silliest
    doubts. But I feel 99% of the time they go only by books, from my personal experience. In India
    a doctor would say by looking at your face, yes you are anemic but there the doctor will come to that only after a blood test.
    Once while in the US I took my son to the doctor with clear signs of the beginning of chicken pox. The doctor told me this is a case of scabies. I said it definitely looks like chicken pox and I would like him to get the shots so the blisters may not be that severe.
    But the doctor would not listen to me and send me back with some
    ointment. The next day the blisters were all over the body and I took the kid to
    clinic again. There was a different doctor as the old one went for
    vacation. She said ‘OPS he got chicken pox, and the shots won’t be that effective
    now. I was upset and wrote a letter to the hospital and the doctor send me an
    apology letter etc .i changed the doctor after that and never had an issue
    for more than 10 years with the new doctor. I know doctors are humans too but she could have at least had a closer look at him before making the wrong decision. And here in India the doctors most of the time don’t even ask what medicines that you are currently taking or if you are allergic to anything!!:)

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  16. @ Anand
    Welcome.
    What you have said is right.The government has a responsibility to the people.The poor should be provided medical care through governmental hospitals.But I remember,when I was young, I would go to the near by Taluk HQ hospital,with a piece of paper.The hospital didn't have paper for prescription!.Things have improved to some extent.But still,the lack of hygiene and facilities would prevent anyone from going to these places.It would take a day for someone to stand in the queue,to see a doctor and get ,may be two paracetamol tabs,if he is lucky.

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  17. @ meera
    As medical students we were taught the art and skill of clinical examination.Our training was probably suitable for our needs,based on available resources.There would be no tests for someone who has an ordinary fever or any other mild illnesses.Now a day,you would notice that there is no clinical examination.Everything is based on investigations.When I started working as an internist, I could make a diagnosis of a liver abscess,and aspirate it blindly with a syringe and needle.No one would think of doing such a procedure in the US.They would do an ultrasound guided aspiration.But then,it would cost ten times.
    In Europe and US,patients are seen with appointments.A doctor would see may be ten or twelve patients a day. The queue at the govt hospitals are kilometers long. I had seen over a hundred patients when I started working at a govt hospital.Quality care is not possible.

    Some newer hospitals are stylish,like the one you mentioned. Expansive lobbies and comfortable seats and perfumed air and receptionists dressed up like air hostesses and all.But,they charge you for every smile they give you.

    With all the modern facilities and training,doctors in America are not immune to mistakes.In fact ,it is surprising that they make more.
    Doctors cannot stick to a working time.It is a difficult job. But,they should be given sufficient remuneration,so that they wont be lured in to corruption by private institutions.

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  18. In answer to the question you left on my blog re: how I chose which books I read. I like to think of myself as a person who will give anything (reading wise) a go at least once and as I hadn't read anything by this author before I thought why not give it a go.

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  19. 'They charge you for every smile they give:)'.Indeed!

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  20. Dr Antony,

    I am not a doctor. But generally speaking I disagree with you. I think most Doctors and / or Physicians are okay but there is a small number who degraded the profession. I just look at the majority.

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  21. Hello Dr.Antony,

    Well,our profession is a noble profession but doctores dont care anymore...I had to undrgo 3 surgeries just bcos the first 2 surgeons dint do it properly...finally a plastic surgeon from Chennai Apollo diagnosed properly and did the right thing..The other two people dint even apologise though we know them personally..They dont care anymore...Too bad..

    Dr.Sameena@

    www.lovelypriyanka.blogspot.com
    www.myeasytocookrecipes.blogspot.com
    www.samsondentalclinic.blogspot.com

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  22. @A
    You could be lucky.Or you would be at a place where they have better living standards and social securities..Where they don't pay a million to buy a seat for MBBS and another million to get a PG admission.No one would spend millions to study medicine and then serve humanity! There are four government colleges in Kerala and almost a dozen private medical colleges which came up in last five years!!

    I work in UAE where the salaries are not bad.But most of the doctors in our hospital have resigned because the private hospitals lure them with offers of percentage. When medical insurance is compulsory, patients can choose between private or government hospitals.Doctors in private hospitals draw double the salaries because of the insurance related practice.

    Where do those belong who cannot afford this insurance?.In India, 80% cannot afford the medical insurance.That leads to two kinds of practice. One for the affluent and another for the poor.

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  23. @ Dr Sameena
    Welcome. Such things happen in practice.Everyone doesn't have the same skills,but all do the practice. The reason for such issues is because they don't refer patients to experts for fear of losing their practice.

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  24. This is very interesting and true. I also think most doctors give to many prescriptions. I always looked at this as the doctors answer to not knowing what is wrong with us. I agree with health insurance, the cost is sky high and now they tell us what we can take and they don't cover a lot of things, so we have to pay more. At least my doctor does spend time with you and he listens.

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  25. Hi Doc, was at Rachna's place noticed your callsign and busybody over.
    I enjoyed reading your this very eloquent posting, especially your mention, ".......The former are called Doctors. The latter, Physicians". I like this.
    You have a pleasant week, Doc, best regards, Lee.

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  26. @M Cloud
    Because of misuse,some insurance companies have suffered as well.They place too many restrictions now.
    @ Colorful Lee
    Thanks for the visit.Come often.
    I enjoyed your blog as well.

    ReplyDelete

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