Dr Google will now see you

Ranjan Yumnam *

A Google a day keeps the doctor away. It’s as easy as that. Dr Google is affordable and accessible and always in our pockets. The real doctors in white coats are hard to meet; they probably work in several hospitals and suffer their own bad hair days. Due to their training and the public’s ignorance of medical knowledge, they often come across as patronising to us–the patients.

Dr Google, on the other hand, gives you instant medical information and home remedies, searches the depths of the web and your guts to find diagnoses for the symptoms and dig up relevant information before visiting a hospital.

I had a direct experience with the doctor industrial complex when I got infected with Coronavirus and was admitted to a local hospital. The doctors were not mean to me per se; they were kind, competent, and resourceful.

However, centuries of elitism have made doctors see their patients as commodities and data points. Once you enter the hospital ward, you lose all your individuality. As in prison, you are identified by your bed no. Mine was bed no.7 while I was treated for Covid in 2020.

There is nothing wrong with giving equal treatment to all the patients in a ward. A hospital ward is a flattening experience, a place of homogeneity, where individuals must give up the entitlement they experience outside the hospital. I realised that it was not equal treatment but a universal dehumanisation of the patients.

Nurses came in and went about with trays of medicines and patients’ records, and they were most faithful to the doctor’s instructions in those papers held in the clipboard. The nurses were covered in protective costumes aka PPE, making the interaction more impersonal and mechanical. What little smiles they flashed inside those masks, I would never be able to divine.

While giving injections and checking my daily vitals, they held out their hand like a pole touching a carcass. The feeling was mutual. I don't fancy their touch either, especially when they have contacted so many other infectious patients with the same instruments. This is okay.

We were all uncertain about the protocols of caregiving and receiving during the pandemic. We were learning even as we were battling Covid-19, experimenting and doing our best. But that is not what I want to talk about.

SKEWED RELATIONSHIP

The doctor-patient relationship is fraught with a power imbalance. Whenever a patient seeks the details of her medication on a doctor’s order, she is stifled with silence and indifference. The nurse will stonewall interaction with the doctors. The doctors will rush their rounds in the ward like a hen picking up the grains, and when asked for any clarification, they reply in monosyllables.

Doctors know best—this attitude by the doctors reeks of paternalism by miles of bandage. The healthcare industry either doesn't trust patients enough to share knowledge, or the professional code restricts it.

The first code is the Hippocrates Oath, which doctors are beholden to upon completing their training. The Oath exhorts doctors to care about the ‘beneficence’ and welfare of their patients. Taking a cue from the Oath, the doctors hold enormous power over the patients on the grounds of upholding the best interests of the patients. Moreover, the patients who approach doctors are not in their best physical and mental condition; they are primarily sick and in their worst mindset.

They are in a dire time when they feel most needy, fearful and insecure. The men in white coats reinforce the desperation of the sick class, and the hospitals serve as the superstructure that perpetuates it. The doctors treat patients as infants that need strict parenting, order prescriptions and medical interventions, demanding immediate compliance–resistance is futile and risky.

So, as I lay in the hospital infected with Coronavirus, the doctors became my parents. Hospital visits by relatives were restricted. The nurses and assistants gave me pills and injections, and I didn't know what the cocktail was all about. Nobody thought it necessary to enlighten me of the usefulness of the prescriptions on my health.

But I felt better. Whether it was the nature healing the body or the medicine curing me, that’s another matter. It is well known that placebos can cure 30% of most of the illnesses. Pop a white sugar pill, and you will feel better, studies say. Even more appealing is the colour of the pills. Blue pills have positive psychological effects, and any injection with salt water seems like a major treatment executed by thoughtful doctors.

A mock surgery is akin to groundbreaking medical progress made on your anatomy. The important point is that the sickness heals itself sometimes, and the presence of authoritative doctors and nurses accompanied by a bevy of interns is a sight to behold, like the God appearing before you.

MEDICAL PATERNALISM HAS A HISTORY

Our local doctors were only following the long-regarded tradition of medical paternalism. In 1847, the American Medical Association's Code of Ethics stated: “The obedience of a patient to the prescriptions of his physician should be prompt and implicit. He should never permit his own crude opinions as to their fitness, to influence his attention to them. A failure in one particular may render an otherwise judicious treatment dangerous, and even fatal.”

It is shocking to find out that as late as 1960s, doctors thought disclosing a diagnosis of cancer to be dangerous and detrimental to patients. So, all the treatments for cancers were done by duping the patients as if they are sick with a benign disease. Daddy knows best, dear patient in bed no 14.

The medical fraternity's aloofness to patients is what drove people to astrologers and alternative healers. Astrologers, in fact, are placebos. Their hit rate is determined by randomness and probability. Their advantage is that they are accessible and friendly. They listen, empathise, and treat you as a human being with ambitions, hopes, and a checkered history that doctors don't care about or are too busy to appreciate.

Patients want a diagnosis and a favourable prognosis. Though all medical conditions cannot be cured, we want a warm smile, assurance, and expert examination that satisfies our soul and body to the greatest extent possible. Many doctors fail on this front massively.

In medical care, psychology, especially the one championed by Freud, is an outlier when it comes to treating the patient as a unique, multifaceted individual. Psychotherapy recognises the autonomy and personal history of the patients; it delves deep into their past, suppressed memories, and subconscious thoughts, which are characteristics of human beings.

Instead of 7 minutes that allopathic doctors allot to an appointment with a patient, therapists give a patient hearing and let the client reminisce and introspect to arrive at a shared understanding of the troubled psyche. The approach here emphasises communication, cooperation and partnership, not a doctor minding a clueless person.

A.I LEVELS HEALTHCARE SYSTEM

This asymmetry of knowledge and power dynamics between doctors and patients is hopefully coming to an end. Thanks to the Internet and its offshoots like Google and AI, mobile phones are surpassing the skills, accuracy, and accessibility of real doctors in flesh and blood. Wearable devices are just the beginning of this transformation of mediums for obtaining valuable and credible medical information about our health.

Having a smartphone is like having many MDs in your pocket, at your beck and call anytime. With this technology, we can quickly probe the doctor’s prescription and their treatment strategy. The pills we pop are no longer a mystery; their purpose and pharmacological properties, down to their molecular structure and titration, are within our grasp.

The traditional doctor’s grip over information about medical conditions and treatment plans has loosened. Technology has demystified the inscrutability of trade, and its workings are becoming more transparent. And this should be the way it is. The recognition of our rights over our bodies and the availability of options through digital education for making health-related decisions herald a new age.

However, we must give due credit to the fact that doctors act in patients' best interests and decide treatment plans based on their extensive training, experience, intuition, and best practices, which the patients lack. It is not expected for an ordinary man to be well qualified and in a position to navigate the potential medical interventions.

If at all they are knowledgeable, they simply can’t perform the complex medical procedures and fill prescriptions for themselves. One can’t expect to have the institutional support, types of sophisticated equipment and diagnostic tools that are available with professional caregivers.

While this logic seems infallible, the history of organised healthcare has borne out more hubris and arbitrary action on the part of the physicians than their professed care for the patients. Records since the Hammurabi era, have revealed instances of systematic paternalism and authoritarianism by caregivers.

DOCTORS ON TRIAL

To cite an infamous period, the medical trials that were conducted on the prisoners by the Nazis are horrifying. The shocking human trials in the concentration camps marked the height of doctors’ paternalism with little regard for the patient’s consent. The experiments included testing the effects of biochemical weapons, exposure to extreme environments, eugenics, euthanasia, etc., and the victims selected as guinea pigs based on racial considerations.

As a result, the medical fraternity was rocked to its core by the medical atrocities which were brought to legal and ethical scrutiny in the Nuremberg Trials known as the "Doctors' Trial" (1946-1947). These trials led to a movement towards ethical treatment and privileging of patient rights. They shifted the doctor-patient relationship favouring patients' autonomy and self-determination in the treatment journey.

Eventually, Bioethics and Autonomy have become a part of the medical ethos that underscores respect for patients’ autonomy, beneficence, non-maleficence, and justice.

PATIENTS EMPOWERMENT

While the men in white coats have come to grudgingly acknowledge the patient-centric philosophy, the magic of Google and AI is accelerating the transformation of attitudes. With smart medical devices connected to the internet and cloud applications, patients now have a powerful means to access and analyse their medical data and participate in the decision-making process regarding treatment options.

This brings us to an exciting development in the healthcare landscape that may disrupt the medical field. AI has wreaked havoc in all other sectors, and downsizing in hospitals is entirely plausible in the days to come as AI and a slew of smart wearable devices will become commonplace.

The kind of empowerment driven by AI that accrues to patients will be beyond limits. If your pricey doctor refuses to meet you and gives you a cold shoulder to your requests for a meaningful conversation, fret not; Dr. Google is your saviour. Unlike the real doctor in the clinic, Dr. Google doesn't get tired, snobbish, or pressed for time. This should be a painless transition.

Earlier, I used to hanker after doctors, dipping my hands into my goodwill bank to reach a doctor. Now, I am spoiled by choices and second-of-second opinions. I can't thank Dr Google and AI enough for this convenience. I rely on these nameless and humble workhorses to read my prescriptions, X-rays, and lab reports and evaluate the quality of my daily dose of drugs.

HEALTHY PARTNERSHIP

In my enthusiasm for the new technology, I exaggerated a bit about the obsolescence of doctors. Despite what the doomsayers say, the doctors are here to stay. I was pointing out a smoking gun, and I might have inadvertently created a needless scare. The experience, skills, and intuition of surgeons, dentists, physiotherapists, paediatricians, and diagnostic specialists are crucial and irreplaceable.

The perils of total reliance on AI for self-medication may be fatal, and smart devices should be used to enrich the engagement with doctors and supplement their advice. However, considering that people have become more aware of medical procedures and the science behind them, the monopoly on medical knowledge is broken. In this scenario, it will bode well for caregivers and clients to respect and treat each other as partners.

For most minor health complications, a smartphone is worth many human doctors. Knowing that instant medical expertise and assistance are available in a smartphone in my pocket is a liberating thought. Do you have a different opinion, Dr Google ?