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The art of healing....Not any more

>> Sunday, April 25, 2010

I am looking at the world a bit differently these days…not as a physician,but as a husband whose wife had a brief, dramatic encounter with the health care system, and as a father who had an ailing daughter in law at the hospital. Our experience started me thinking:  How did we get in to the point where the driving force in medicine  is the bottom line, where a system supposed to give care and compassion  to the suffering has deteriorated in to something of a money spinning business.

Hospitals have mushroomed in our places  over the last few years. Naturally it is commonsense knowledge to assume that investing millions in to  a hospital is done because it has become lucrative, and their purpose is not simple service. Many of them look as good as five star hotels with designer lobbies, and charming receptionists dressed up like flight hostesses. Once you are admitted, the scenario changes in to an extraction business. Doctors are too busy to talk to patients. You see them walking in and out of ICUs, as if they are doing great life saving procedures ,never bothering to look at the faces of those waiting anxiously outside.
While waiting as an attendant outside the ICU, I also realized how ignorant our public are about common medical  conditions, and how easy it is to mislead them giving half correct information. For someone at the height of stress having their dear ones kept  unseen, and not knowing  what is happening to them, money matters become of no concern. They will pledge what ever they have to save the lives of their dear ones. Human relations transcends all money matters, and it should be that way.

My wife had an attack of chest pain at the middle of the night. While she was in the emergency  room, my wife informed the doctor that her husband is a physician and would like to know some details.
I introduced my self and started off the conversation. He gave me his name and said
“ I am the cardiologist here” and went in to explain that my wife had an attack of unstable angina.
“ We need some one to sign the consent” he said
“For what “ I asked
“ For angiography’ he said “ The senior cardiologist will come only if you sign the consent for angiography”
I was surprised and said” But  how does he know she needs angiography without seeing her?”
“This is the policy here” was the reply.
I called a classmate of mine who was working as consultant cardiologist at the same hospital. From the history and ECG findings he said “ It is not that urgent to do  an emergency angiography, and can be done electively, but I can’t see her today officially because I am not on call today” he managed to postpone the procedure temporarily. I took the earliest flight  the next day morning. By the time I reached the hospital, they had already managed to get a consent from my son, and done the procedure. He said the doctor frightened himself and his mother so much, that they requested the doctor to do the procedure. What can we call this  other than ‘ emotional blackmailing ‘? When doctors are paid incentives for the procedures they do, the number of procedures increase in proportion. I met the doctor to whom I had talked over the phone and found that he was a junior doctor in the department.

I work in a hospital where we deal with heart attacks on a regular basis. In fact, our most common emergencies are related to ischemic heart disease. In the last five years, we had the  need to send very few patients for an emergency procedure. Most are treated conservatively and sent home, and we reassess them for further treatment options. There are no studies to show that the emergency interventions benefit the patients in a better way, except when carefully chosen. But, they are the main source of income for hospital and doctor alike.

“Hi Tech Hospital” is the term used to describe hospitals now. “ Super Speciality” is another terminology. Even small hospitals at the road side  display big boards written “ Super Speciality hospital and Research Centre”. Research of what? I am yet to see  the results of any studies or researches coming from these kind of hospitals. Ther are no more ordinay hospitals or ordinary doctors.

Technology is not what matters to the patients. They want to know someone will look after them and tell them what is going on. They want an assurance that their medical team is focused on their well being. Through words and actions they want to be told , “ we care about you”
It is ironic that with all the advances we’ve made in medical science, the thing patients remember  is the one-on- one ,human side of medicine.

Everyone in a hospital helps deliver health care, from the security guard to the registration clerk, cleaning staff and cafeteria workers. They set the mood. Similarly physicians and nurses cal alleviate patient apprehensions with a few extra moments of personal time. A touch of hand or a pat on the shoulder can ease a worried mind and send a patient’s confidence soaring. If a physician simply sits down in a patient’s room, it makes a big difference. Patients sense  you are focused on their problem. You’re not peering down at them.

         Few weeks back, I was called to the resuscitation room in the E R. A young Indian man was being resuscitated. He was unresponsive and had shown no signs of life when brought in. The story was that the man was coming out of a travel agency and suddenly collapsed at the road side. The ER doctors had attempted a resuscitation which was unsuccessful. I often find it difficult to stand and witness such events even after years and years of experience. It was  while I wasx trying to get some history of the event that the cell phone in his trouser pocket started ringing. The loud rings were annoying in the  bleak silence of the room. We had no option other thn to extract the phone and answer. At the other end was his wife from India calling to inform that they will reach the airport in time to receive him. Also that his new born child was anxious to see her father. I could hear the sweet  cries of the baby  at the other end. I couldn’t talk to the lady for long and was relieved when some of his  relatives arrived at the scene.Now is’ it inhuman to produce a huge bill form somewhere at that juncture ? I know of incidents where the dead body was not released for lack of payment!.

There are times when I think whether I should have chosen this career. Some times  I worry that  I have become part of a system of well planned looting of patients. I had no doubts when I started off as a young doctor. I believed I could do many things for people. I thought I had learned everything in medicine to heal  the sick. Over time, I regretfully realized how wrong I was. Now I know, the very  little  I can do for them. Only those who destined to live reach the hospital. Roughly one third of patients with serious heart attacks die at the time of attack. And what if one developes  it  at the middle of no where, while travelling, or when alone without assistance to reach hospital?  If the best of treatments could prolong life, the richest would have lived longer. But does it happen so? I remember having read in the Oxford Hand Book.  There is a total disarray of deaths in nature. If nature had followed norms, the oldest should die first, and the youngest should live longer. But does it happen so?  As doctors, it says, our only role is to bring some order to this total disarray of deaths. How true !

 On the other side, everything loses value, if given free. It applies more to the services you offer free. I never refuse if someone asks me to bring a relative or friend to my clinic. The rules at my work place make it mandatory for patients to pay some fee for consultation. But then, there are many poor people who cannot afford to pay even that. But the sad part is that  the person often doesn’t realize the value of the service. A doctor who sees the patient immediately, probably has no value. He becomes important when the patient waits for him for hours to get his turn to see the doctor.. And then, his value  increases along with the cost of medicines he prescribes.

I don’t think there is any other profession which has been so much commercialized. With the result, medicine has lost the human touch. We do key hole surgeries ( and often do not care what is left behind. It is more money than open surgeries and apparently attractive) and even robotic surgeries. There are medical programmes  now, which gives you diagnosis and treatment, if given sufficient data. And the time is not far, when an educated patient can do it himself with the help of a computer. The gentle, emotional tie between the doctor and patient is already broken. And that is why more and more of litigations and manhandling happens in the medical field. The profession has changed in to a business, like anything  else. Some people invest crores of rupees to   transform their incompetent children to doctors, and then more to make them specialists. It is not surprising that they see the career as an investment and try to reap the returns at the earliest.
There is all the more reason to include in the education the acquisition of” human touch”. One can always argue that however  kind a doctor is, the patient will die if he lacks knowledge or skill. There is also the danger of too much emotional involvement of the doctor. Such considerations do not justify the doctor treating the disease, and not the patient. Because of the pressures of today’s medical education, nothing is demanded of the student than to acquire masses of of information, with little thought for integration and correlation. I have always thought, “ every one learns the same books ,but then how come some are good doctors and others not? I had often argued with my friends that medical field is something which does not need much intelligent people. What is needed is simple hard work. And it is the application of knowledge which makes some doctors good, and others bad. Some of the best students in my batch, were never able to practice clinical medicine, because they failed at practice. Some of the so called ‘chronic additionals’  became popular doctors and built up their own hospitals and businesses.

There is a factor which transcends all specializations and involves virtually every person in the medical profession..human personality, one of the most useful tools in the  therapeutic arsenal. I could say a doctor is guilty of negligence if he neglects his own personality as a therapeutic device, leaving the “ human touch’   to the relatives or some of those prayer group members who are waiting to jump on to them. “ The most human of all arts”  is becoming not an art at all, and degrading in to  nothing other than a money making business.



Money Matters

>> Sunday, April 11, 2010

Not that money is not important. But I had never experienced money taking over relationships.It appears that money has an intoxicating effect on some and they find it difficult to part with it.Long standing relationships get forgotten easily,when matters of money and wealth creep in.

The truly troubling part is that so many of us have become willing accomplices to what is best described as a war of money against life. It starts, in part, from our failure to recognize that money is not wealth. Wealth is something that has real value in meeting our needs and fulfilling our wants. Modern money is only a number on a piece of paper or an electronic trace in a computer that by social convention gives its holder a claimon real wealth. In our confusion, we concentrate on the money to the neglect of those things that actually sustain a good life.

It's simple, humans are social beings. Just think about how we come into the world. We're born unable to eat on our own. Unable to stand on our own. Unable to even communicate! Our helplessness at birth highlights our need to depend on others. Without the care and love of another being, we would simply die. And it's the same whether you are a child or an adult.

So why we have begun to take relationships and family as less of an importance to other things like careers, money and wealth? If money can't truly make us happy, but people can, shouldn't we invest more time into developing our social skills? Into learning additional ways to connect? We've all heard stories of the millionaires that commit suicide... but still we will sacrifice friendships and family over the pursuit of money.

It is always good to learn to think that we have enough.When you believe in lack, then the logical extension of that is to think there will never be enough to go around and you had better grab what you can before someone else gets your share. The less you think there is to go around, the more motivated you will be to grab even more, out of fear that you may suffer from not having enough. You may even fear it to the point that you start grabbing what might be considered other people's share, and that's when you start being accused of greediness.I have come to believe that whenever we make choices out of fear and doubts, we will find the results unsatisfying. So if greed is based on a fear, it should therefore turn out to be unsatisfying for the one who acts greedy. I can think of examples where this came to pass; but I can also think of cases where the greedy seem to be enjoying the goodies they have grubbed and grabbed for. Is this a paradox?

Some people enjoy collecting money. I had a friend who used to talk to me about her husband ( though not justifiable ! ) He used to keep strict accounts of money and used to sit late nights calculating his savings.Never used to spend a penny.And his nights simply passed ! Her own salary was dictated to go to his account.About ten years back,his target was a crore of rupees in the bank and was only a bit short of it. I am sure he must be chasing his elevated targets these days. This is something like orgasmic experience to some.

Many people tend to forget that there are more important things in life than money and wealth. Ultimately we cant carry any bit of it when we leave.All the efforts of a lifetime  are just left behind for someone else to waste or throw around.Often,in the process,relationships are trampled. Many are left wounded. 

Healthy relationships with others encourage healthy relationships within (and vice versa). The next time you face problems regarding matters of relationships.... remember what's important in life! I'm learning this too, but here are some things I think can help us all:

Do not let money and wealth creep in to and eat our relationships.People can be around our coffin, shedding tears, money cant, since it has no feelings.Talk openly about your thoughts, fears, loves, dislikes. Don't be afraid to share yourself with others who have demonstrated their love and respect for you.  Listen to your friends and family when they speak. Don't make assumptions that you have no basis for. Be honest! Faking interests or experiences just to be close to someone leaves you feeling guilty and anxious. Be honest and trust that you're worthy of love and friendship just the way you are, with or without money and wealth.

Believe in abundance and not in lack.At sometime or other accept that you have enough,and then more to give away.. If you  believe in abundance, you can give away much of your wealth and be secure in the faith that you will always have enough. Perhaps that is what proves your faith, and perhaps those who give away their wealth end up having more and being happier with what they have - or at least being happy with what they have left. Philanthropists are admired, while the greedy and self-serving rich are envied or despised.

I think those who accumulate their wealth with greed will punish themselves by being unhappy with their wealth. We do not have to judge them or condemn them - their own choices will create the appropriate consequences for them. Wealth can be a curse, or a blessing. Look at all the unhappy rich people.It is when you have more,that you find it difficult to part with it.
What matters is what we choose for ourselves

A Law the greedy have not learned:

The Greatest Good For ALL Concerned.
What goes around comes round, they say.



On love and lies

>> Friday, April 2, 2010

I was talking to a colleague the other day. He came to me asking for help.He hadnt slept for weeks.He looked a mess,totally unkept and shabby,on the verge of breaking down.He wanted to talk about his family,his wife going to leave him.With two growing up children,it was bit difficult for him to accept that his wife was walking out on him.She had found a new love, who promised her everything she had dreamt of.And the saddest part was that, the new lover was their closest family friend.She claims,she had never felt love like this before.I told him to give it some time,to let things cool down and take its course.No one can keep a person by force.Whatever you call it,love or infatuation, it cant be prevented.To those who get these feelings,time or circumstances  are of no concern.Such things happen when emotions rule over matters.And when you let your emotions take over your  intellegence.
I have witnessed many such events in my career.

"I love you"  are three little words which are frequently said.. Nothing more. All too often when people say "I love you", the receiver of the words forgets it means nothing more. "I love you" is thought to mean what? I want to spend some time with you? "I want to spend the rest of my life with you", "Let's get married", I want to have sex with you or just "I love you”. What does it really mean?

It just expresses a feeling at that point of time. Nothing else.

And how does it usually start? You see a boy or a girl,something strikes you,and then like him or her and without much delay,decides that you love her.

So, to be honest,the beginning is the appeal. You look at her and then like her.Without knowing anything more about her.And that is what we call love.

I have often wondered why it is called “ falling in “ love. As if you are falling in to a pit. Do we say falling in to marriage or falling in to friendship? Thinking about it,I admire the one who coined the term ‘falling in love’. Because ,as easy as is to fall in love, it is easy to fall out of it. Isn’t it? If not, how come they offer all the untold things in the world and forget every bit of it? And forget the same person you adored all the time, and go on with your life as if nothing happened?

People do not mean a word of what they say when they are in love.

“I hate you. That is not true, but sometimes I think it is. I will not answer the phone when you call, even though I want to talk to you. I will not call you, even though it is all I want to do. I will not reach out to you, even though every part of me wants to. I will be mad at you, I will want to hurt you, I will drive you away because I am afraid to let you closer. I need your constant attention, your reassurances, but I will greet them with cold indifference. I will be jealous of the attention you give others, and I will get mad at you for ignoring me. I will feel close to you and care for you one day, only to be mad and want you out of my life the next. I just cant live without you. You come in to my sleep and I cant sleep thinking of you. Every breathe I take,you are there. You are there,in the air I breathe, and in everything I do. And I cant think of a life without you. And I will die without you”.   Probably,this is the usual sequence, and often the terms used when people think they are in love. But how long do these feelings last?

And how many of these promises last? Do they ever remember they talked this way?It is always good to remember the other person is  sometimes left behind broken hearted and wounded for the rest of his life.

Are we emotional amnesiacs? maybe.

 But is it possible to forget and forgive easily ?People who are  simple minded and sentimental, falls victim and end up messing up their lives. They lose purpose and direction in life, and goes after the new found love. Those who are clever and intelligent, they draw a line where to stop and when they think they had enough of fun.

Memories follow you sometimes like a curse.Memories fade and warp,but never die. Cant be erased or wiped clean. Forgetting is easier said than done.The one thing that you want to forget, probably occupies most of your memory. Like I had written once earlier, every wound leaves a scar, however well healed. The scabs can bleed again.

The greatest pain that comes from love is loving someone you can never have.The love lives then, breaking up the person.It is a different story,once you get the person.

 Relationships are like glass. Sometimes it’s better to leave them broken than try to hurt yourself putting it back together.


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