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Medical profession down the ages: From individual art to 'authoritarian' science

By Dr Amitav Banerjee* 

Entering medical college in the 1970’s was a totally different experience than it is today. We felt we have arrived unlike today’s medical students for whom the MBBS course is the first step on a long, stressful and uncertain professional journey.
As first year medical students, we were full of hope and youthful optimism. A doctor, even a mere MBBS, was worshipped next to God, those days. We were eager and impatient to become one. The four and a half years stretching before us seemed so long away. And it really was. Time used to move much slower those days. We believed that once the long wait got over we would be equipped with supernatural powers which ordinary mortals do not have. We will be able to prescribe a pill for every ill, and eliminate human suffering.
There were no coaching classes for entrance into post-graduate seats; internship was a period when we learned the trade with many hands on experiences. By the time we would finish internship we were confident to handle medical emergencies as a first contact physician. 
There was no desperate scramble for a PG seat either. These were allotted on order of merit decided by the marks obtained in our MBBS University exams. Those who did not get a PG seat did not get disappointed either. They either joined government service, where they had a fair chance to get a PG seat later as “in-service” candidate while others started their private practice (remember doctors, even MBBS ones, were next to God).
Well, this was the bright future we were looking forward to during our first year in medical college. Our Dean, Dr M P Mishra, was a very learned and wise professor of Medicine. He was also a Second World War veteran. The Dean and other faculty too had a less hectic and stressful life those days. There were no frequent or surprise MCI inspections. And NAAC was not invented yet! So the Dean had some spare time on his hands. 
Though a professor in Medicine, he would teach us Physiology once a week. On this pretext he had his finger on the pulse of the student fraternity. His wisdom made him understand the ignorance of first year medical students about the limits of medicine.
None of us could forget the introductory lecture he gave us. It was humbling. He asked the class, if any one of us knows how to drive a car, not very common those days. Most of us rode bicycles. Only one girl raised her hand. He asked her to imagine what would be her options if her car broke down in a village where there is only a cycle mechanic. She hesitantly answered she would ask the cycle mechanic to help her start the car. 
The Dean told us that after we become doctors we should always remember that when we approach a patient our level of understanding would be akin to a cycle repair man trying to fix a car. By some luck the cycle repair man may identify a loose wire or a fused plug but will be unaware about any major problem in the engine.
Similarly, we may be able to assist in fixing a cataract or a broken bone, but most of the mechanisms by which a body heals itself will elude us. With all our learning and skills we cannot defeat nature. He taught us humility before nature which confers immense self healing powers if we obey its laws by healthy lifestyle and artful living. Dr Mishra, our Dean taught us the limits of medicine.
The second memorable lesson we learned was during our clinical years as a medical student. We had a lecturer in Medicine, Dr Tejwani, whom we fondly nicknamed, “Teju-Kaka.” His clinical acumen was almost supernatural. Those were the days when the only non-invasive investigation we had access to was a plain X-Ray. When we were medical students, there was no ultra-sound, CAT-Scan or MRI.
But Teju-Kaka’s clinical acumen compensated for all these. And during our bedside clinics it was a treat to watch him exercise these skills. He used all his five senses simultaneously while examining patients at the bedside, often more than one at a time. For instance with his stethoscope he would be listening to the heart sounds of a patient on his right and with his hands he would be feeling the abdomen of the patient in the adjacent bed while looking at the ECG of a third patient! He rarely missed the faintest of clinical signs.
We often remember him finding a borderline pleural effusion (fluid in the chest cavity), even before the patient had an X-ray chest. Teju-kaka would categorically state that the patient has a slight fluid collection on the right side of the chest and none of would be able to find any “stony dullness” the sign indicating it. But lo and behold when the X-ray would come we would see the report something like, “blunting of costophrenic angle right side, suggestive of pleural effusion (fluid), please correlate with clinical findings!”
Dr Tejwani, taught us the art of medicine, a life-long endeavour. The Art is Long; Life is Short, as Hippocrates put it. Dr Tejwani did live a long and fruitful life; he left for his heavenly abode a couple of years ago well into his nineties.
Alas, with advancements in medical technology like ultra-sonography, CAT-scan, and MRI, we are making strides in the science of medicine at the cost of the art. While the science helps us make more precise diagnosis, the art bonds the patient with the doctor. We are losing touch with our patients, literally. 
The present generation of doctors should combine both the art and science of medicine to establish better doctor-patient relationship which is taking a beating in spite of medical advances. Doctors too take a beating, occasionally. They are no longer considered next to God. They will be if they practice the art sincerely. Science without art alienates.
The third and final lesson was from a teacher who was a legend in his lifetime, as he is today. He was Dr J E Park, our Professor of Preventive Medicine (now called Community Medicine). He had very high standards of integrity and hard work. His classic Text Book was in its second edition when we were medical students.
He had written the book when there was no access to internet or online resources. There were no laptops or computers. He would be in the library taking copious notes by hand. Writing a book was difficult labour those days. He would fondly carry the book, like a mother carrying her baby, no wonder. While Dr Mishra taught us the limits of medicine, Dr Tejwani the art at the bedside, Dr J E Park taught us scholarship and beyond.
Authoritarian medical scientists during pandemic arrogantly endeavoured to give illusion of control over all citizens of the world
We were all intimidated by Dr J E Park, or rather by his book. Whenever, in viva he would ask us any question and we got stuck, he would admonish us for not reading his book from “cover to cover.”
But he valued virtues more than even scholarship. One day in class he told us that whatever he teaches or the contents of his book, will be forgotten by us or they will get outdated with time. He emphasized that scholarship without virtues is impotent. He gave us the “3 Cs” to follow in our professional career. These were “Creativity,” “Critical thinking,” and “Courage of our Convictions.”
He went so far as to say that if we take an oath to follow these “3 Cs” we need not read his book from cover to cover.
Next time when I faced Dr Park in viva and got stuck he again admonished me for not reading his book from cover to cover. I answered that I will take an oath and follow the “3 Cs.” His words of wisdom to my naive response was, “Young man, in your long professional career you will many a time realize that following these three “Cs” is more difficult than reading any book from cover to cover!”
Looking back, I must say, I have experienced this many times in my professional career. Last year, I got the honour and privilege to Chair the Oration in memory of my late teacher. I took the opportunity not to read his bio-data given to me, but narrated the three “Cs” I learned from him to aspire for. A difficult path, but worth the effort.
The pandemic years illustrated how the lessons from these three great teachers were thrown to the winds by the global medical community. Bureaucratic medical experts, world leaders and administrators under pressure to give an “illusion of control” downplayed the natural forces of nature and tried to overcome them with disastrous results and collateral harms. Pandemics are natural phenomenon, they come and go like tides in the sea.
Warning systems to protect the vulnerable or “focused protection” advocated by the The Great Barrington Declaration which was based on the art as well as the science of medicine, would have prevented many deaths of despair. Early in the pandemic it was evident that the elderly, the obese and people with co-morbidities, were 1000 times more vulnerable than the young and healthy.
Our Dean in the seventies, made us realize the challenges in treating a single patient. Authoritarian medical scientists during the pandemic arrogantly endeavoured to give an “illusion of control” over all citizens of the world, benefiting the laptop class who could work from home. The rich got richer and the poor got poorer. Actual and long lasting -- “social distancing!”
What about the clinical skills and the human touch with patients Dr Tejwani taught us so painstakingly? These were already decaying over the years with costly investigations and machines. Litigation by patients also promoted defensive medicine in case a remotest possibility of a disease got missed and the patient going to court.
This also reflects the deteriorating doctor-patient relationship due to medical advances and corporate model of health care where doctors and patients move like assembly lines in a factory. The good old family physician and general practitioner cannot sustain independent practice due to cost of advances in medical technology and also low trust among the masses due to the glitz and glamour of super-specialist hospitals.
During the pandemic one of the most unexplainable decision was to shut medical schools all over the world and resort to online medical education further distancing the medical student from the patient. This will lead to a generation of future doctors who will be paranoid of touching patients and examining them for fear of infection. 
Each occupation has its hazards, and occupational infections are the hazards of the profession – in fact most medical students develop natural immunity to the common infections, provided they attend bedside teaching. Closing medical schools during the pandemic years was like closing military training centres during a war!
However, the greatest failure of the medical profession during the pandemic was the failure to practice the 3 “Cs” – Critical thinking, Creative thinking and Courage of conviction, taught to us by Dr Park. Few of the medical fraternity stood up for science when it was suppressed. 
An editorial in the British Medical Journal (BMJ) titled, “Politicisation, Corruption, and Suppression of Science,” poignantly concludes that when science is suppressed, people die. Majority of the medical fraternity were silent fearing professional repercussions. They lacked the most important “C” the courage of their convictions. Without this “C” the other “Cs” are impotent.
Future physicians will be lacking the other two “Cs” as well. For Critical and Creative thinking you have to see the whole rather than a part. With specialization and sub-specialization, the physician today is like one of the 5 blind men feeling an elephant! Or shall we replace “elephant” with “Disease X” which is already being promoted to cause the next pandemic with far more lethality and contagiousness (anyone who knows the “whole” of immunology will know that “lethality” and “contagiousness” do not go together, as highly lethal pathogens are dead-end infections and do not go far!).
Not only the profession, medical education too is also driven by commercial and political interests who will not like to have future critical thinking doctors spreading “mis-information” and being a nuisance. The future doctors will be an extension of their robotic machines blindly implementing the guidelines given by WHO, CDC and other authorities. 
The Pandemic Treaty and the amendments to the International Health Regulations are in the offing for medical authoritarianism to take over. Who needs thinking and knowledgeable doctors? No wonder the Health Ministry has reduced the qualifying percentile to join post-graduate courses to “zero!”
---
*Epidemiologist, presently Professor, Community Medicine, in a Medical College at Pune. He had served as an epidemiologist in the armed forces for over two decades and also a medical teacher for over three decades. He has written the book, Covid-19 Pandemic: A Third Eye

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