1.5 – 1.6 Physician and Patient

1.5 Who is a Physician?

In times as these, the word physician has become synonymous with a person holding a medical degree in Allopathic medicine. A layman would naturally trust him as the State has certified him. Very few patients really know what kind of training is involved in the making of a doctor. There is also a wide range of differences between one medical doctor and another, be they from the same college. The percentage of marks do not matter—the practice of medicine requires many skills such as good observation, memory, ability to make sense of the information given i.e. information processing, judgment, sincerity that keeps one updated about the latest developments in the field and, most importantly, an empathy with the patient. Besides, medicine is a science as well as an art. It also requires an intuitive sense, something that all good doctors have. But in the age of rapid commercialisation all these things are fast dwindling in doctors, leading to a growing dissatisfaction. There are other factors as well such as the commercialisation of the medical profession where getting a medical degree involves lakhs of rupees and many students join it only or mainly because it will give much better returns later along with the social status. There is also the problem of rapid industrialisation and the fast pace of life leading to a swift increase in diseases, the concentration of the doctor and the patient around the urban areas so that on an average the physician gets much less time per patient despite the swell in doctors, hospitals and medicines available today. It is as if the patients were exponentially increasing with an increase in the hospitals and the doctors! One reason attributed to this is an increasing health awareness but another reason could be a loss of natural faith in the body’s own capacity to heal so that now the patient visits the doctor for smallest of problems fearing some serious consequences of ignoring it. In short, there is a changing pattern of diseases and the challenge this change imposes is perhaps not being met by doctors, who more often than not, are overworked.

What could be the solution?

First of all, especially in a country like India we must encourage alternate systems whose healers were once deliberately marginalised by the British mainly for political purposes. It is time that we recovered our lost confidence and started a systematic exploration of some of the ancient systems and their merits and strengths. This would reduce the burden on the exchequer and also take healing to the villages where although, we still have the traditions alive,  it is much like a sick unit fast disappearing due to lack of State support. Perhaps it is worth studying whether the plants found in the native areas are gifts of nature to tackle most problems found in that region. The only catch of course is the flip side of globalisation, what with fast food and the changing rhythms and exposure to new toxins, neither our habits nor our habitats remain natural anymore.

Still, it is interesting to note how the ancient systems viewed this once noble profession. In Ayurveda, for instance, a physician had to be a dwij, or twice born. That is to say he had to be born in the spirit as much as in matter. This term was used in those times for persons who were initiated into the secrets of spiritual mysteries. In fact, even in ancient Egypt and Europe, it is the priests who became the physicians while the barbers went on to take care of surgery. In India, whether physician or surgeon (and many elaborate techniques and even instruments of surgery are described in detail) one had to be a person well-versed and learned, both in his branch of study and in his understanding of the spiritual side of life. The physical, the psychological, the occult and the spiritual were all considered before deciding the type of medication to be used and the prognosis.

Just as a human being is not merely a body or a mind, the physician too must be able to understand and help the patient on all the levels of his being, that is, be sensitive and knowledgeable not only about the physical but also the psychological and spiritual side of his patient. All this is unfortunately still very far from the realm of actuality at the present moment. But perhaps some reflection of it can be seen in the concept of the family physician. It is a meaningful concept and can be replicated in some way. It always helps if a patient can have one particular physician as the common nodal point through which he can be routed to others if necessary. And besides, the physician gets to know the unique situation, the general physical and psychological condition and above all the inner resources that help in the recovery process.

An ideal physician is still a far cry. But if one has to envisage such a person, he should have, apart from the theoretical and practical knowledge of his subject, a wide and generous heart, a cheerful and kind predisposition, a positive outlook and indefatigable energy and most of all faith—faith in himself, faith in the healing process, faith in the possibility of cure, and, most of all, faith in the Grace. In other words, a physician is more than just someone with technical knowledge. The big bane of present times has been this divorce of everything from the deeper purpose of life and the subtler forces that move us.

 

1.6 Who is a Patient?

 There is a tendency to view a patient as someone who is suffering from an illness. However, we often forget that this ‘someone’ is a living and thinking creature. Physicians are too often used to looking at a patient as if he were a physical object. The reasons are many. First of all, medical training right from the moment of entry begins to condition the student to look at a human being as just another machine. Anatomical studies on cadavers, study of separate parts taken out from a dead body (there is no other way of course), infuse this sense. Young interns begin to discuss their patients as if they were cases for study. I remember how, when I was admitted with a pain in the abdomen, the young interns started discussing among themselves all the possibilities right in front of me. While discussing them, they would even make a joke or two and pass casual remarks about cutting the abdomen as if it were a cake. It was horrifying to say the least. And one gets used to hearing songs and jokes in the Operation Theater, presumably to ward off the tension. Finally seeing ‘dead bodies’ and walking away the very next moment after ‘doing one’s bit’ only reinforces the de-sensitisation process. Perhaps it is necessary at some stage for a physician to be relatively insensitive to the patient’s pain or else he would never be able to work upon him. But this practical de-sensitisation often enough turns into an insensitivity with its attendant consequences.

But perhaps there is a better way, a higher way if one may say so. It is possible to take a spiritual stand, to regard a human being as a developing soul, growing in spiritual experience through both pain and joy, through suffering and through happiness. While working upon the body, even when one has to isolate it from the rest, one must always remember this truth in the background, that one is not dealing with just some chemicals and a conglomeration of cells. This way, one would perhaps avoid a lot of unnecessary reactions that arise within the patient due to unwitting remarks of their physicians or other health-care personnel. One must be especially cautious about prognostications about illness and the course the disease may take. Medical treatment is a peculiar thing where the physician may end up reinforcing a scientific superstition by repeating it to a patient over and over again! Each such remark, whether scientifically proven or not, carries a potent force to set into motion mechanisms in the patient that begin to work in the direction of the fear being generated. The mind of man is a powerful equipment for good or for worse, as more and more physicians are recognising lately. It is a great art to know how much to say and how to say it. Especially when it comes to speaking about a statistical truth we must be careful that we are not turning it into a gospel truth in the patient’s mind. Later it becomes a self-fulfilling prophesy and only reproduces itself in further statistical studies till new findings and some breakthrough comes and suddenly the fresh statistics begin to flourish. Very few physicians realise (some do and exploit it rather) that their patients often treat them as demi-gods placing their entire trust in the hands of the physician. The word of their physician, even sometimes a casual phrase gets translated in the patient’s mind as a truth that cannot be challenged. Sometimes it takes years to undo that and sometimes it becomes again a self-fulfilling prophesy. I remember an instance of a patient who had suffered from breast carcinoma. Many years before being actually diagnosed with it she was told casually by a doctor that she may have breast cancer. Subsequent examination did not reveal anything but the remark stuck in her mind and she often brooded over it. Almost after a decade, she was diagnosed with breast cancer. Whether the doctor was an intuitive one or whether her words proved fatal and started in her patient’s mind a psycho-biological loop feeding the possibility is hard to say. But surely such instances are not uncommon and it will be good to remember that what a doctor says is not necessarily what is understood by the patient. Each mind processes any given information in its own way, adding to that its own bit of fear and hope, expectations and anxiety, thus altering the whole meaning. Many patients do not countercheck whether what they have understood is correct or not; they are often afraid that they may get to hear the worst and that imagined scenario, exaggerated by the physician’s silence, plays upon their minds. Equally many physician’s either do not care to explain or are more interested in making money out of their patient’s misery rather than have genuine concerns about their client’s illness or their well-being.

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