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?