Editorial 4 |

The Practice and Teaching of Medicine – The Idea and Emotions

Atul Goel, Director General Health Service, MoHFW, Government of India

Writing an editorial is always an honor and privilege but it assumes greater responsibility and significance when one is writing for a journal that one was associated with right from its inception. It is satisfying to note that one’s colleagues continued to nurture the sapling, and help it grow further. Practice and Teaching of Medicine have ever been so close to my heart that I can spontaneously relate to it and write about it. While some practitioners of modern medicine consider it a dying art, I personally tend to differ. It is something, that will be valued more with time, like an antique, even though health care industry that has dominated the last 40 years of medicine would try to convince learners and teachers of medicine about the increasing and beneficial importance of technology in health care.

Human beings were meant to be the most intelligent animals on Earth. Unfortunately, in the quest for technology, especially artificial intelligence (AI), they have let themselves down. Of late we have often behaved either like sheep (with a herd mentality) or like elephants (with a distinct set of teeth to show) when it comes to teaching and learning. There was a time when an MBBS practitioner knew enough to look after every patient, because he learnt his art of practicing medicine so well. Today, we say, MBBS has no value, even MD has little value, one requires to be at least a DM or an MCH. I have difficulty in understanding as to how degrees impart competence. To me, the best doctor was Dr T Saha, a simple MBBS practitioner in Karol Bagh area of Delhi (in early 60’s and 70’s), who smilingly held the hand of every patient, listened carefully, cracked a joke or two, which took away the pain of every patient instantly.

The Practice of Medicine that began as an idea of reducing the pain of a sick person has given way to the idea of ‘saving every life’ (which may not be feasible, all the time) through technological interventions, without really analyzing the emotions that a sick person is going through. Therefore, both practice and teaching of medicine have undergone a change from being an art full of emotions to a heartless rendering of service to a consumer without any feelings. Whether this change will be good or bad, only time will tell. Time and Life are always cyclical in nature, with good things always likely to survive difficulties they go through. Like connoisseurs of art, teachers, students as well as practitioners of the art of medicine will always exist to take forward the idea and emotions of the practice.

Let me quote Sir William Osler, “the good physician treats the disease, the great physician treats the patient who has the disease.” If one really wants to have good physicians who can treat patients, one has no alternative but to subscribe to the ideas and emotions involved with teaching, learning and practice of medicine. Human life is hollow and meaningless without emotions. Without emotions, humans would be no better than machines. While the healthcare industry in quest for wind fall profit is floating the ideas of a technology treatment platform for medicine, will it carry any meaning at all? Unfortunately, the administration and political leadership of every country (more so the developing world) seems willing to buy the story of technology in healthcare structure as a solution to every ill affecting human being. So much so that ‘prevention’ of disease has taken a backseat so far in a huge amphitheater created by practitioners of modern medicine, holding big degrees in one hand and instruments in the other, looking forward to interventions in every case, without trying to find out the explanation for the problems faced by the individual.

Worldwide, violence against doctors as well as litigations against health care providers are on the rise. This rise is being countered by increasing security on health care premises and/or promulgating legal provisions. No one wishes to address the root cause, which is responsible. The root cause is ineffective doctor-patient communication, which has transformed from a humane doctor-patient relationship based on true emotions to one of provider and consumer; which is dangerous in the health care setting. Such kind of arrangement for health care will only worsen sentiments related to health. One huge contributor to a humane doctor-patient relationship was human touch, which is being increasingly given up for investigations, technology and now AI. Technology and AI can never be the remedy for diseased health care providing administrative systems that failed to provide uniformly distributed, effective and humane health care to the sick people.

That brings me to the last point of my editorial. This is about medical education. When I graduated from medicine school, curriculums were very much in place, and we were all well trained at the place where such training was meant to be, among the patients, and I loved every bit of my stay among patients in which ever capacity I functioned, intern, resident, faculty, trying to understand every single problem, analyzing it, trying to offer solutions. Every patient contributed to my growth as a teacher as well as practitioner of medicine. I would bring two analogies here. One does not learn to drive by attending lectures or by reading about driving. One learns it by driving on the road. I am sure we all learnt trigonometry in school, although, I am not sure, how many of us used it in life. This by no means makes trigonometry less important. The current curricula of 5 years of medicine have so much documentation that it makes teaching as well as learning difficult if not impossible. Health education for practitioners also needs simplification in terms of the quantum of knowledge (that too without understanding). The time spent on the road needs to be increased for people to become effective doctors, useful to society.

Let us try and prevent the ‘Idea’ as well as ‘Emotion’ of teaching, learning, and practicing medicine from disappearing completely, although, within my heart kindles the hope that human feelings and emotion will prevent that to happen. A parting suggestion would be a ‘read’ for all wishing to take up medicine as a career option – ‘The rise and Fall of Modern Medicine.’