Doctors - demigods or devils?

THE FIRST of July every year is being observed as Doctors' Day. It happens to be the birth anniversary day of Dr. B. C. Roy, an able administrator, popular Chief Minister and above all famous physician. On this occasion let us see how the doctors were regarded in the past and how they are today. Vaidyo Narayano Hari is the saying that used to be quoted often in the past to indicate that the doctor was regarded as God.

In those days people used to suffer from a number of illnesses, some of which ended in fatalities in the absence of medical care. The doctors were only a few in number and they were instrumental in the recovery of the patients in a few cases, and a few cases used to end in fatalities in spite of the best care taken by the doctors, because of the absence of the necessary drugs and technologies in the armamentarium of the doctors. People understood the limitations of the doctors and thanked them not only when the patients recovered but also when the doctors could not save the patients in spite of their best efforts. They used to treat the doctors as demigods.

With technological advances in recent times the doctors are able to treat diseases more successfully and the people have come to feel that all diseases can be cured by the doctors and the patients have no business to die. In case the disease is not cured for any reason - be it due to the condition of the patient when he was brought to the doctor, or age of the patient or other constitutional factors or coincidental chronic illness or the incurable nature of the disease or due to the limited knowledge and skill of the doctor - the doctor is held responsible for the failure. It is but natural that when the patients die their relations and friends are profoundly upset and in their distress hold the doctors responsible for the result and treat the doctors as devils.

In the past there was mutual admiration between the patients and the practitioners so that even if there were any misadventures or mistakes, in spite of the best efforts by the doctor, they were understood and ignored. The doctors were dealing with patients as entire human beings, not just as diseased organs or interesting illnesses.

It is felt that the present biomedical model that said ``specific disease - let us find it; specific treatment - let us give it'' has become inadequate. New programmes in the West are formalising the teaching of social responsibility, ethics and patient centred medicines as part of medical discipline and require courses in doctor-patient relationships, communication skills and cultural, social, ethical issues.

The medical humanism movement stems from a belief that physicians in the West have become distanced from their patients because of the explosion of new medical technologies, the information- intensive education, the increasing cost-conscious nature of medicine and the emergence of a more demanding, litigious and knowledgeable breed of patients. The movement rests on two premises: that the expansion of scientific knowledge has left little time for compassion, intuition and ingenuity - the trinity of the doctor hood - in the practice of medicine.

It is felt that the traditional ``Information intensive approach'' to medical education be replaced with one stressing the acquisition of skills, values and attitudes and that as much emphasis be placed on the development of the physician as a caring professional as on his or her becoming a knowledgeable and highly skilled practitioner.

Dr. R.V. Rajam MS, FRCP, FRS, doyen of venereology and internationally recognised venereologist and famous writer and speaker of his days, mentioned 25 years ago about the doctor- patient relationship which is more relevant today.``With the increasing complexity of medicine and proliferating specialities, the doctor-patient relationship has become more and more impersonal and the people are becoming vaguely dissatisfied with the doctor as a person. They seem to feel that he has become too commercial, too scientific, too busy and too preoccupied to concern himself with the individual problem of the patients. It has become hazardous to develop a serious illness over a weekend or on a holiday or at night because many doctors are not available at those times or fail to respond to an urgent call.''

Some critics like Dr. Seidel at Johns Hopkins say that society plays a larger role in tempering physicians' attitudes than does education. ``Physician should always be caring - I don't think that is an issue'', he says ``but are we a caring society? All these programmes won't really matter unless society changes.''

So, depending on the circumstances, sometimes the public may be correct from their point of view, in considering doctors as demigods or devils. But let them assess coolly and calmly the particular situation and the limitation and treat the doctors neither as demigods, nor as devils but as human beings with their own foibles.

Dr. M. SUBBA RAO

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