Why is there a crisis in medicine?

 

Crisis in Medicine.

Despite all the glitz, it cannot be denied that the world is in the firm grip of the largest medical crisis in history.

• Too many patients
• Too many diseases
• Too few doctors
• Needed, one doctor for every person
• Needed, four medical colleges in every town
• Needed, one hospital in every street
• Needed, one ambulance in every home
• Needed, working 24x7 for money to pay medical bill's

This is the summary of the situation. Compare it to the scenario around independence. Just a few primary government health centres with doctors whiling their time chatting with the few patients that visited and reading newspapers. Prescriptions rarely exceeded two generic drugs with instructions to drink seven to eight glasses of water per day to flush them out. There were medical colleges in a few states. One rarely needed hospital admissions.

So what has changed? The basic principles have been ignored. What are those principles?

• Never medicate a healthy person
• Keep the healthy at the peak of health
• Teach the unhealthy how to return to health
• Create awareness about nutrition, sanitation, hygiene, and special diet and care for acute diseases till they run their course
• Medication under supervision only when absolutely necessary
• Doctors job is to counsel, comfort, and do as much nothing as possible
• The words of doctors, the white coat, the stethoscope, and their comforting words have a powerful placebo effect that needs to be harnessed
• The stethoscope, tongue compressor, a torch, and the doctors hands and eyes are the diagnostic tools
• The doctors need to observe society and surroundings to ensure public health
• In India doctors raised a ruckus when aluminium utensils were introduced. They wanted proper town planning and disposal of waste. They protested excessive chlorination of water. They warned patients against stressful lives, anger, and anxiety pointing out they led to grave diseases. They protested tobacco and its use even as globally doctors advertised and recommended cigarettes. They castigated patients who visited during hot afternoons and advised them to come in early morning and evening hours.
• Doctors on an average spent 30 minutes to one hour per patient trying to get at the root of disease.
• Doctors quietly warned patients about vaccines. There were plenty of such doctors. These were the doctors who informed Gandhi, Rajagopalachari and Patel about the vaccination scandal and wanted vaccines to stop. They petitioned the government against the practice pointing out the relationship between vaccines and extremely serious chronic diseases like tuberculosis, leprosy, cancers, and mental diseases like schizophrenia.
• Doctors routinely performed skin tests before giving injections, a practice not limited to antibiotics. They asked patients to wait for half an hour after injections so they could be observed.
• They were against suppression of fevers unless they crossed a limit. They advised washing the head and massaging the soles of feet to bring down fevers. I know doctors who advised dissolving a 100 mg crocin tablet in half a glass of water and taking a spoonful if fevers remained high. At that time a 100mg tablet of crocin was considered a very high dose.
• Pregnancy was out of bounds for medicine. Nutrition and evening walks, continuing to do routine household chores was recommended. Caesarians were almost non existent.
• There were no "child specialists". Medicating children was considered a sin.
• Doctors voluntarily attended public functions hoping that their mere presence reminded people about the need to remain healthy.
• In Odisha there were many private doctors who treated the poor for free
• I have often times written about doctors like seniors Jagannath and Gadadhar Mahapatra, Dr Kar, Dr Raghu Sahu and others whose prescriptions were rare but advice profound. They often verbally and mercilessly abused their patients for not following their advice on lifestyle and on abandoning addictions.
• Doctors found time to write columns in newspapers about the need for morality and ethics in society. Many wrote regular columns on religious texts like the Jagannath culture, Gita and Upanishads.
• The doctors respected the choice of patients to look for alternatives. "Any pathy that offers sympathy is good for health," was a comment we often heard.
• I have also written about how doctors prescribed kitchen remedies and ayurvedic formulations and wrote them down in their prescriptions.
• Even after medical representatives appeared on the scene many doctors kept them away from their chambers. I was once in the chamber of Dr Indramani Jena when he took on a very senior medical representative and put him in his place for suggesting prescribing a doubtful medicine. "Don't you dare teach me medicine," he shouted, "remember always, you are a mere salesman. I am a physician."
• Even today pathologists and doctors like Dr K C Mahapatra and Dr Sriharsa Das manage by doggedly staying away from the commission network.

Where do the doctors of today stand in comparison? Medicine is a passion. The moment it becomes a for profit livelihood it collapses. If there is no difference between a medical representative and a doctor then the public should stay away from that system.