https://meditropics.com/practice-of-medicine-art-science/
PRACTICE OF MEDICINE: ART & SCIENCE
L H Ghotekar
HOD, Department of Medicine, LHMC, New Delhi
I take this an opportunity to touch briefly on three vital topics in medical field in India. Three topics are the way medicine is being practized, teaching and learning medicine and research in medicine.
The practice of medicine has changed a lot in last few years. Young physician relies more on investigations than history and clinical examination. Using expensive laboratory or imaging tests in preference to clinical acumen in the making of a diagnosis is becoming all-too-evident. History taking is getting neglected. Communication is a key skill to be inculcated among the young professionals who will be the leaders of the profession tomorrow. Effective physician interrogates patients’ choice of words as well as their body language. Mere investigations will not help in diagnosing disease as disease states are never identical even when caused by the same organism. Unnecessary investigations should be avoided and at the same time one must do relevant investigations as early as possible to reach to diagnosis based on history and clinical examination. Detailed and careful examination needs to be supplemented with important and relevant investigations. Practizing medicine is also an art and not only science. “Wherever the art of medicine is loved, there is also a love for humanity.” – Hippocrates. There has to be a right balance. I remember a patient misdiagnosed as enteric fever based on false positive WIDAL test who had fever later confirmed case of covid who was admitted in critical condition in a severe hypoxic state but fortunately survived. These practical skills need to be learnt bedside and cannot be learnt in lecture theatre or books.
Teaching and learning have changed in this fast pace of life of internet. Everything is changing, online learning, mushrooming of various training institutes and pattern of examination. It compels students to focus on bookish knowledge and less on practical learning. Interns and students do not wish to spend time in ward and like to be in rooms or library. That is the reason newly qualified graduate is often unable to practice independently in urban set up these days leave apart practizing in rural area. Inadequate training could cause an error or negligence which could lead to a lawsuit and leads to many issues like misdiagnosis or failure to diagnose, unnecessary or incorrect surgery, premature discharge, failure to order appropriate tests or to act on results, not following up. prescribing the wrong dosage or the wrong medication, leaving things inside the patient’s body after surgery, operating on the wrong part of the body etc. Another important reason is that medical graduates do not understand that practice of medicine is more an art than a science. One must focus on developing bed side skills which cannot be learnt from books. Bedside teaching and learning are still crucial and we in India are in advantage. This makes Indians at better place globally. We have to take advantage of technology in learning. For example, using the auscultation mannequin, students learn heart sounds through hands-on practice in an environment most similar to actual patient care. The simulator is capable of playing back different heart sounds or murmurs at each auscultatory site. But it will never replace the original. Proper method to be learnt during physical examinations and investigations should supplement to reach to diagnosis out of the clinical differential diagnosis. So much can be written on this topic.
I do not mean that all fault lies with doctors even patients are not willing to be proactive to avoid medical problems. More so, as per former governor of MCI Dr Devi Shetty said, “India has approximately 300 medical colleges producing 30,000-35,000 graduates every year, whereas the need is that of 500 new medical colleges, producing one million doctors every year.” As in various institutes faculty are busy in private practice are unable to impart proper training to under and postgraduates. Government should provide extra remunerations to teaching faculty, the present NPA is very meagre. The advocates of present NPA may say that faculty have chosen the different path as they were free to enter private practice. It’s true to some extent but it is their sheer keen and prime interest in teaching career. If everyone chooses private practice it will jeopardize education Institutes.
The way research activities are conducted in various institutes has also changed at various level. Residents plan research mainly in area where investigations are very important part of research. Commercialization focused research is diluting the quality. Residents takes up this important aspect of learning very lightly. As much as 90% of the published medical information is flawed according to John Ioannidis, one of the true experts on credibility of medical research, and former BMJ editor- in-chief, Richard Smith, has claimed that most of what is published in journals is just plain wrong or nonsense. Similarly, publications quality has demerited due to many indexed journals are publishing manuscripts on payment basis. New houses have come up where researchers pay them to publish the articles. This is devaluing research and younger lot are attracted to this lucrative offer. Some professionals use this short cut practice to make their biodata impressive or for promotion. Bad people will find a way around the laws while good people do not need laws to tell them to act responsibly.
A caution to young generation not to fall pray of this speedy captivating but unethical way.
All is not as bad as mentioned. Fortunately, younger newly joined undergraduates are enthusiastic in learning and doing research. They are excited about research, and it is our duty to guide them, show them the right path. Mere preaching will not work. Teachers and senior practitioners must set examples of rational, scientific and selfless treatment of patients.
The science of medicine is progressing to help us to overcome/solve new health challenges. Newer investigations techniques, molecular genetics, genomics, biomarkers, radiological and imaging advances etc. helping us to clinch the diagnosis early and will see the rising sun witnessing the brighter aspects of medicine. As Dr. William Osler rightly said, “The good physician treats the disease; the great physician treats the patient who has the disease” and I understand it should be the purpose of learning medicine and serve the mankind. Aim of study of medicine is to save lives. Where there is hope there is life. Not all angels have wings, some have stethoscopes.