Wounded healers - III
Common mistrust of the profession

Dr S Pahel Meitei *

Faith is the essence of the patient-doctor relationship. Without faith, the relationship is non-existent and the patient is highly unlikely to benefit from the doctor's care. It has been proved in many studies that cancer patients with positive attitudes are more likely to improve or live longer than similar patients with negative attitudes. Psychology plays a very important role in the patient-doctor rapport and in various determinants of treatment outcome.

However, with increasing consumer activism, the patient-doctor relationship is now mostly being viewed as consumer-service provider relationship. People need to ponder if it is alright to place the patient-doctor relation at the same ethical status as the customer-shop keeper relation. The stakes are definitely not the same. People need to see the difference now: people used to see the difference in the past.

The mistrust is also partly being fanned by the internet as well. Other than the fast spread anecdotal cases of the "Dr. Money" or "Dr. Death", people get both the precise or correct information and imprecise or wrong one about any medical topic. However, they are more likely to stumble upon the latter sort of information-wrong or imprecise.

You cannot process the information that you get in a logical way if you do not have the scientific wherewithal relevant to medical science. That is where the proverbial adage comes: little knowledge is a dangerous thing! What is becoming commonplace is a phenomenon of mistrust of the doctors' intentions by the people in general. While it would be reasonable to say that the black sheep among the medical fraternity are to be blamed in part, exaggerations, generalizations and irresponsible reporting by the media has been the main cause. It would be wrong to shift the entire blame to the doctors.

The general mindset is now being "comsumerized". The primary objective for any other professional is "to earn a livelihood". But, the primary objective of medical professionals is to alleviate people's sufferings and to save people. Earning a livelihood is necessary and hence remains a secondary concern, but it is never the primary concern with majority of the doctors. Moreover, a doctor's livelihood depends on his services to the patients.

Quite routinely, the doctors give money to the poor patients to buy medicines and to get tests done. Many doctors do not charge any fees from poor patients. Many doctors give free treatment to the needy sections of the society at far flung areas. Many doctors and other health professionals have caught infections from the very patients they have been treating, and many have died while serving the infected and needy patients.

Medical professionals make a living by helping and healing people. I doubt you can say the same about any other profession. A person who happily spends 200 bucks for a popcorn serving at a movie hall will sound "Dr. Money! Dr. Money!" when he has to spend 200 bucks for consultation with a doctor.

Things are only getting gloomier with people, most prominently a semi-educated actor called Mr. Amir Khan, portraying it as if it is a crime for doctors to earn money! They want the doctors to provide free services! What for? Mr. Amir Khan charges around 2 crore rupees per episode of his dumb TV show, Satyameva Jayte, for dramatizing everything "Bollywood-style" with exaggerations, mindless generalizations and lies concocted by ignorant fools behind the show, but he wants doctors to work for free!

He says, "If they are money minded, they should have gone into business or some other profession" since, he reasons, they are very intelligent and talented people! What a dumb statement! First, he does not even know the fact that every person has a few set of talents.

Secondly, he seems to think doctors are robots with no humanly lives of their own! Thirdly, he cites the example of a few dark horses among the doctors and generalizes it to criminalize the entire community. A doctor sacrifices his childhood and youth for the sake of his profession, and he is expected to sacrifice his few remaining years of life as well! All because a certain dumb-brain-with-a-nice-face called Mr. Amir Khan, and the ignorant and selfish people think that is the only sensible way!

All these people do not have any problems with judges, lawyers, bureaucrats, police officers and uneducated politicians accumulating crores and crores of mostly black money. They are celebrated as "achievers". The question here is: who does not need money? Why should people expect doctors to sacrifice, sacrifice and still sacrifice? Doesn't a doctor have a family to run, responsibilities to bear, a life to live or dreams to fulfil?

Why should it be a problem if a doctor sacrifices his personal and family life to serve and save patients and gets rewarded for the same? Miracles Need Valour! Miracles do happen because someone or some people had the courage to think out of the box and gave their task their best shot, with no fear for the consequences. Medical science is a field where the doctors and other healthcare staff are always faced with the perpetual task of treating patients and trying to save patients from the jaws of death.

Now, if they have to work with the condition that they cannot fail and that they should save all patients under all circumstances, do you think they will be able to eve work? If they have to constantly fear for the consequences of losing their patients that may even include their own death, they will naturally stop seeing serious patients and stop working. When people bring the death bodies of patients to the treating doctors' houses, and when people vandalize the treating doctor's house after the death of a patient under the doctor's care, and when people extort money from the doctor or hospital after the death of a patient, which doctor do you think will ever take serious patients under his care? Miracles will naturally stop happening. Patients will cease to improve or to be saved. What is in store for the people?

Manipur has a very distinctively profound the-grass-is-greener-on-the-other-side mentality among people. For them, doctors in Guwahati (even if they got their degrees from nondescript colleges and are running nondescript clinics in the small corners of the city) are superior to local doctors (even if they got degrees from reputed colleges and are working in hospitals with far better facilities). Top it with the current trend of mob injustice and extortion from doctors and hospitals. Doctors will now refer each and every problematic patient to outside centres.

At the outside centres where people cannot take a mob along, they cannot even utter a word in protest. The logic is simple. That implies 1) more financial burden on the patient's family, 2) more inconvenience and hardship on both the patient and family members, 3) more patients dying for lack of timely intervention, 4) more patients dying for lack of the financial resource and 5) more patients dying during transit.

That also will on the long term lead to a gradual exodus of the healthcare professionals from the state (the way Indian doctors are fleeing to US, UK and Australia), and to a gradual death of the specialty and super-specialty healthcare centres in the state. That will again lead to a vicious cycle of more inconvenience and hardship, more deaths and more expenses for the common people. Moreover, doctors are now faced with an urgency to get quick results.

Hence, they more frequently resort to irrational use of therapeutic agents like the frequent use of high-end broad spectrum antibiotics leading to micro-organisms fast developing resistance to these agents, something that is difficult to be matched by the extremely slow rate of development new antibiotics. This will ultimately lead us to an era of pan-resistance when disease causing microorganisms will be resistant to all available antibiotics! Anyone can guess the consequences. Whoever catches an infection will have to die! That will theoretically be the end of the mankind. Reasons doctors still love being themselves

Belonging, as they usually do, to the top echelon of their respective classes in school days, doctors seem to relish the very idea of cut-throat competition that they must be able to get through at every stage of their life, right from before they get entry into their basic MBBS course. Cathartic experience it must be for them with a lot of sacrifices to make right from the moment they decide to get into the profession.

A senior doctor at AIIMS, New Delhi once told me, "Though we may be highly underpaid in India, though we may even be dying of infections that we contract from patients and though we may be dying at the hands of the ignorant patient parties, we still are the only people who are fortunate enough to live with the daily thrills of being able to save dying patients, to perform miracles for people who have lost hopes and to bring positive changes in other people's lives!"

He went on to explain how the few among other people who were ever fortunate to have made any positive contribution to other people's lives would live with that pride all through their lives. For all the young kids who aspire to become doctors, I would like to stress that doctors continue to be the light of hope for people surrounded with the darkness of despair and that we have not become paupers after becoming doctors.

It is a different matter that many people still want to see the half-empty bottle, rather than the half-full bottle. Be a doctor, and serve the mankind and at the same time make sure that you live your own life well. Let other people say and do whatever they want to.