Doctor’s Dilemma

Dr N N Dutta

(The writer is Chairman & Managing Director, down town hospital, Guwahati)

My earliest memory of a doctor is of Dr. Tulsi Choudhury (not a formally trained doctor) going around our ancestral village donning a bamboo cap on a bicycle. He would go around offering door to door visits and reviewing the ailing. The members of the village would offer him whatever they had as fees. Someone would gift him a bunch of bananas. Another warm glass of milk to drink. The awe in their faces towards the healing doctor was a sight I still recall with a sense of wonder and amazement till date.

One could say this was a turning point in my life.

When we joined the Medical College, the selection process was on the basis of Higher Secondary marks and availability of seats. Teachers were dedicated and highly qualified who took due care for holistic development of their students apart from training them to be medical professionals. Though it was not a part of the curriculum, good ethical practice was also taught to us to be a good doctor. We were taught to approach the line of treatment and treat any patient as our own relation. Nowadays, many colleges have come up with capitation fees, entrance exams allegedly deteriorating the medical education.

In the early 60’s abdomen was a magic box. We were told why the diagnosis was Exploratory, Laparotomy, as treatment at that time was done by intuitions. The health system seemed to be full of exceptions, exclusions, contradictions and intuitions. Healthcare has long been just on the cusp of massive advancement from Modern Medical Equipment and devices to patient empowerment. Thanks to all the Modern Medical Gadgets, in today’s time, diagnostic equipment includes medical imaging machines like X-ray machine, CT scanners, ultrasound and MRI machines & PET scanners. Treatment equipment includes infusion pumps, medical lasers and LASIK surgical machines. Using an endoscope, a flexible tube with a light and camera attached to the head, the digestive tract can be viewed and to take a biopsy (removal of tissue) to look for the presence of disease. Technology will likely underlie most aspects of future hospital care. But care delivery especially for complex patients and procedures may still require hands-on human expertise.

When a patient comes for treatment; a sincere doctor’s first thought is to treat and cure him, which is the most joyous thing on earth for him/her. Apart from personal satisfaction, the basic inspiration is to bring a positive change in someone’s life, to make sure that a particular diagnosis is correct, the next operation is successful. The spirit of care is what makes it worth the long hard hours of working in deplorable conditions, with death looming over around. There is no doubt about the true fact that doctors are doing a noble deed by serving mankind but it doesn’t mean that they are to be wretched for any errors. It is very easy to blame doctors for wrong treatment for a patient’s death. But in some cases when it comes to treatment that turns out to be successful, the efforts of the doctor is ignored by all and people bargain for the fees.

The recent change in the attitude of the society is tragic. The doctor is perceived more as a ‘service provider’ rather than a dedicated professional. Medical practice has become extremely distrustful. Physicians always worry about missing a warning diagnosis, accidentally spreading infection or committing a technical error. The fear stem from an intense nervousness of dealing with the many grey areas of medical practice - the realization that medical science is also an art rather than simple scientific formulas. The fear is also the result of self protective paranoia of being sued for malpractice, which haunts majority in this field at present.

However, there is another side of the coin. The life of a practising physician is incredibly rewarding. Making challenging diagnoses, helping patients deal with and overcome devastating illnesses and comforting families after a loss of a loved one - these are powerful emotional experiences. No other profession can provide such profound sense of fulfillment as this.

It is hard especially while announcing critical medical conditions and near death situations. However equally rewarding for a doctor to experience the smile of relief, happiness on the faces of the patients and the attendants of a cured one. Undoubtedly it is still the best profession to be able to give back to society. However despite helping save lives over the few decades the sense of fulfillment is depravating gradually. Saving a life is no longer great or appreciated in our society. It is viewed as a mechanical obligation as you would from a Robot or machine. This dulls ones sense of joy and fulfillment. However we still follow the oath we could as we joined as young doctors. “To treat the ill to the best of one’s ability, to preserve a patient’s privacy, to teach the secrets of medicine to the next generation, and so on.”

However it is imperative to note that Doctors too are humans. Similar to others in different professions they too lead a family life with their myriad issues. Apart from juggling the stress of being responsible for someone’s health and wellbeing. Being a doctor and having the responsibility of many lives is even more difficult and exhausting. As a parent they have had to miss several PTMs, Annual school program’s while attending to the well being of a sick patient. As a spouse they have had to miss out on birthdays, anniversaries. The family members of a doctor too are required to compromise and at times sacrifice on their family time and outings. It is so normal for a Doctor to get interrupted via phone calls from the on duty hospital physicians who need to discuss the on-going care of patients. If it is a private hospital, they also keep getting messages and alerts from patients about the changes in appointments and cancellations at the last minute. But however if a single call is missed the patients will keep calling repeatedly not taking into consideration that the doctor may be genuinely busy.

Nowadays, newspapers are full news related to medical negligence. The first thought is always wrong treatment. This usually happens more in private hospitals as the patient needs to pay for their treatment. If the patient expires, most people tend to think that there must have been some negligence from the doctor’s side. It is true that sometimes judgment of errors of a doctor may lead to wrong treatment. But blaming the treating doctor for death cases has become very common these days. We often hear about the intolerable heartlessness of the medical professionals and malpractices at the hospitals, which is also known as Medical Terrorism. Now with the frequent visuals in news headlines which has become a heated topic of discussion. We often get to hear that a doctor misleads a patient for his own benefit, acts violent, creates a situation of fear in the mind of the patient and their family, after doing a negligent act. The doctor may be same, disease may be same but the response may vary from patient to patient.

Always and never are two words which doctors should not use dogmatically in medical field. My friends and relatives come for treatment to our hospital probably the reason being that they trust and have faith on me. When they get discharged after recovery it makes me feel joyous but there were instances and cases when they expired or their treatment was not successful. And the comments and blame game of the attendants is sometimes very distressing.