FEATURE
Want to be a doctor?
Think before you leap!
Prof. B. M. Hegde,
hegdebm@gmail.com
Wait! While medicine is a wonderful profession if practised ethically, it could be a curse if it is transformed into a business, like any other money making craft. Young as you are, at your age of 17-18, you are liable to be drawn by the medical claptrap that you witness daily in the media. The reality is far from what is seen in those advertisements. If your idea is to make a quick buck and “enjoy” life, please look for other easier avenues where your actions might not result in human misery. Medicine is not for those that are looking for a business. It is a long and arduous course in addition. Many of you, who have got very high ranks in the qualifying examinations, thanks to the multitude of coaching classes that teach the tricks of the trade in the present examination systems, might find it hard to master that enigma, the human body, which follows the non-linear mathematical rules and the science of chaos. You would not have studied those disciplines so far. Serious doctoring needs serious thinking and not parrot repeating the books as you might have done till now.
The one profession that gives overall job satisfaction still remains the profession of doctoring. That said, I must hasten to add that the pleasure comes only when one does not concentrate on the monetary returns. Money will come but, more than all that, it is the joy of seeing the gratitude in the eyes of a grateful patient who naturally thinks that you were his savior although, in effect, it is the human immune system that cures. As the common saying goes doctor just dresses the wound, it is God who heals the same. That brings us to the central focus of medical practice. A great physician of the 18th Century, Sir James Spence, once wrote that whole world of medicine revolves round two human beings. A human being who is ill or imagines being ill comes to seek the advice of another human being in whom the first has confidence (faith). It is this summit, the medical consultation, which is the most vital part. All else in medicine, like the medical school, the hospital, the laboratory and, the library should flow from this summit. Patient’s faith in the doctor is the basis of the so called placebo effect, which stimulates the patient’s immune system to cure the disease. It is otherwise called the Expectation Effect. (EE)
Therefore, you must remember that medicine could only be learnt on the bed side. Each patient is like a mini book. No two patients are alike even with the same disease as every disease presents through the personality of the patient. The habit of learning the books by heart, as you have been doing so far, does not work here. Books are necessary to keep in touch with the basis of medical practice. William Osler, the great medical teacher of the early 20 the century, had this to say about the books. “Learning medicine from the books alone is like swimming an uncharted sea, while learning medicine without books is not going to the sea at all.” How very true? Every medical student should learn to listen to patients. Listening is more difficult than talking. Lord Platt, one of the greatest of teachers at the University College of Medicine in London, was of the firm opinion that “if you listen to your patient long enough s/he will tell you what is wrong with her/him.” This statement, made in 1949, has been recently ratified by a very sophisticated study in London. I can vouch for the same with my nearly four and half decades of teaching medical students and managing patients experience.
Before you jump into the bandwagon ask a few relevant questions of your self. Can you smile at some one naturally? Can you touch some one naturally? Do you have an insight into another human being’s problems? If the answers to these three questions are in the affirmative, you are the ideal candidate for the medical course. If not, and be sure about that, you better avoid that profession. It is not a bad idea to have first hand experience of dealing with sick human beings before you finally take the plunge. Even while one is in the 10th class, the summer vacation could well be spent doing some volunteer work either in a hospital, nursing home or an old age home where you will see first hand the pain, suffering, the filth that might surround the sick, the smell of infected wounds, the moaning and groaning of the sick, tragedy of unexpected death and the resultant reaction of the near and the dear ones on their bereavement, as also the poverty that drives people to be sick in the first place. This could be experienced even now. If you are comfortable go ahead. If not do not suffer all your life as doing anything that does not make you internally happy is a great distress that might drive one crazy as also make one a patient even. Make your work your play and you enjoy life.
Many systems of medicine being practised in the world:
Whereas modern medicine takes the cake in the field of medical care delivery, it need not be the only or the best. There are equally good systems of medical care that need to be scientifically authenticated. Efforts are on all over the world to do just that. Recent audits have shown that modern medicine, which uses the wrong linear mathematics as its base is slightly off balance like the Tower of Pisa. Prohibitive and ever increasing cost of medical care in the present corporate hospital set ups, the unacceptable dangerous side effects of the multitude of drugs used today and, the clear evidence of over diagnosis and over interventions have resulted in patients looking for avenues elsewhere. Unfortunately, as of now there are no guidelines for patients to use the complementary systems scientifically. Every system of medical care, of which there are plenty all over the world, led by the ancient Indian Ayurvedic system, seems to forget that they need to update their methods using the modern scientific methods of testing.
Recent estimates of the very high budgets of complementary medicines in Europe and the USA have induced many players to come forward to authenticate those systems. Sooner than later it will have to fructify. The future of modern medicine might be confined to emergency care and corrective surgery at the most. Medical education in India is crying for reforms but the tardy pace of the governmental jaggarnaught moving and the money power of the vested interests are hampering those effort. It has to happen soon for the good of mankind and the profession if the latter has to survive in the present day world. Paternalism in medicine has to give way to partnership in medical care where the patient takes a keen interest in his/her treatment. Literate patients today could get access to most of medical information on the internet and the former have become vocal about their role. This is good augury. It becomes incumbent on the good doctor to transform those informations to knowledge and finally to medical wisdom to succeed. Novice will find it very difficult in this jungle of information to get at the rose wood. S/he needs a good guide to do that. That is the pivotal role of a teacher in the medical school. The down side of that is the defensive medicine that the star performers use today to save their skin. Defensive medicine turns out to be exceptionally expensive as all the tests are done for all patients irrespective of the need.
Medical education must move from the four walls of the class room of a tertiary care hospital to the community where the student gets to see diseases naked. In the teaching hospitals the student gets to see the filtered lot of chronic, serious and incurable diseases. The latter are a microscopic minority of diseases in society. Lest the student should get a distorted version of the disease prevalence in society the teaching has to be in the community. Only one medical school in India does that and that is the MGM College in Wardha. They are also advanced in that they have seen that all out patients are first managed by the Community Medicine department in the hospital and the specialists come into the picture only when their services are needed, avoiding thereby unnecessary suffering for patients with minor illness syndromes. The latter form the bulk of the sick population anywhere in the world. This kind of new approach is seen in many foreign medical schools. Surfeit of specialists is a bane of medical care arena as is clearly shown by a 14 industrialised countries survey of health status and medical care published in the leading American journal, JAMA (2000; 284: 483) This study, Is US medicine the best in the world will be an eye opener for all entrants to the medical college.
The biggest disease:
Poverty is not only the basic cause of all diseases in the world ranging from common cold to cancer, poverty is the largest disease load in the world. Not knowing where one’s next meal comes from is the greatest risk factor for killer diseases like heart attacks and caner! While there are about 39-40 million AIDS patients in this world, about whom you hear and read every day, there are 840 million who are malnourished and another 540 million live on a meagre income of less than a dollar a day. These are our real heroes looking for good doctors to do something about them. 6000 children die daily in India due to the complications resulting from malnutrition. India has the largest number of malnourished children in the world, a total of 67 million in all. This is much bigger than the total load of such children in the whole of Sub Saharan Africa!
With all our governmental efforts in the last one decade India’s load of malnourished children fell from 47% in 1997 to 46.4% in 2007! What India needs for its health are the following: clean drinking water for all, three meals a day uncontaminated by human and /or animal excreta, avoidance of hookworm menace with toilets for all, avoidance of cooking smoke coming into the house in villages containing deadly carbon monoxide killing children and mothers in large numbers, economic empowerment and education of women, nourishing mid day meal for all pregnant women to beget healthy children, good family welfare schemes, primary education for all, prohibiting alcohol and tobacco-the two deadliest enemies of good health and, employment opportunities for the able bodied. Unemployment is a big risk factor for killer diseases!
While you would read about AIDS, heart diseases and diabetes daily in your news papers and you get to see illustrated medical star performers eloquently championing those disease managements, no one ever talks about the greatest disease-poverty. When you become a good doctor and a star performer please help the poor. God will bless you. Serve them and you will be rewarded. India needs a new medical care system which combines the best in emergency care and corrective surgery from modern medicine and the rest of the 90% patient population to be able to get well using the selected authenticated methods in the complementary systems of medicine to do most good to most people most of the time.
Ayurveda and homeopathy are also good systems if one wants to study them scientifically and then get into research to take knowledge forwards in those areas. You would be the pioneers. Your parents might not encourage you there as they would think that your social status might not be the same as modern medical doctors. Truth is otherwise, though. West is looking to Ayurveda and other systems to lessen their unnecessary financial burden of the top heavy modern medicine. Before you take your seat in the counseling table try and see the movie SICKO if you can. Good luck to you all. Try and get what you want but after that do all that you can to take knowledge forwards in that area for the good of mankind. What changes is progress and that which does not change becomes dogma. May the medial profession get its due place in society as in the past where doctors were looked up to as God incarnates!
“Life is a school. Those who learn to love and help others graduate with honors.”
Anon.
Think before you leap!
Prof. B. M. Hegde,
hegdebm@gmail.com
Wait! While medicine is a wonderful profession if practised ethically, it could be a curse if it is transformed into a business, like any other money making craft. Young as you are, at your age of 17-18, you are liable to be drawn by the medical claptrap that you witness daily in the media. The reality is far from what is seen in those advertisements. If your idea is to make a quick buck and “enjoy” life, please look for other easier avenues where your actions might not result in human misery. Medicine is not for those that are looking for a business. It is a long and arduous course in addition. Many of you, who have got very high ranks in the qualifying examinations, thanks to the multitude of coaching classes that teach the tricks of the trade in the present examination systems, might find it hard to master that enigma, the human body, which follows the non-linear mathematical rules and the science of chaos. You would not have studied those disciplines so far. Serious doctoring needs serious thinking and not parrot repeating the books as you might have done till now.
The one profession that gives overall job satisfaction still remains the profession of doctoring. That said, I must hasten to add that the pleasure comes only when one does not concentrate on the monetary returns. Money will come but, more than all that, it is the joy of seeing the gratitude in the eyes of a grateful patient who naturally thinks that you were his savior although, in effect, it is the human immune system that cures. As the common saying goes doctor just dresses the wound, it is God who heals the same. That brings us to the central focus of medical practice. A great physician of the 18th Century, Sir James Spence, once wrote that whole world of medicine revolves round two human beings. A human being who is ill or imagines being ill comes to seek the advice of another human being in whom the first has confidence (faith). It is this summit, the medical consultation, which is the most vital part. All else in medicine, like the medical school, the hospital, the laboratory and, the library should flow from this summit. Patient’s faith in the doctor is the basis of the so called placebo effect, which stimulates the patient’s immune system to cure the disease. It is otherwise called the Expectation Effect. (EE)
Therefore, you must remember that medicine could only be learnt on the bed side. Each patient is like a mini book. No two patients are alike even with the same disease as every disease presents through the personality of the patient. The habit of learning the books by heart, as you have been doing so far, does not work here. Books are necessary to keep in touch with the basis of medical practice. William Osler, the great medical teacher of the early 20 the century, had this to say about the books. “Learning medicine from the books alone is like swimming an uncharted sea, while learning medicine without books is not going to the sea at all.” How very true? Every medical student should learn to listen to patients. Listening is more difficult than talking. Lord Platt, one of the greatest of teachers at the University College of Medicine in London, was of the firm opinion that “if you listen to your patient long enough s/he will tell you what is wrong with her/him.” This statement, made in 1949, has been recently ratified by a very sophisticated study in London. I can vouch for the same with my nearly four and half decades of teaching medical students and managing patients experience.
Before you jump into the bandwagon ask a few relevant questions of your self. Can you smile at some one naturally? Can you touch some one naturally? Do you have an insight into another human being’s problems? If the answers to these three questions are in the affirmative, you are the ideal candidate for the medical course. If not, and be sure about that, you better avoid that profession. It is not a bad idea to have first hand experience of dealing with sick human beings before you finally take the plunge. Even while one is in the 10th class, the summer vacation could well be spent doing some volunteer work either in a hospital, nursing home or an old age home where you will see first hand the pain, suffering, the filth that might surround the sick, the smell of infected wounds, the moaning and groaning of the sick, tragedy of unexpected death and the resultant reaction of the near and the dear ones on their bereavement, as also the poverty that drives people to be sick in the first place. This could be experienced even now. If you are comfortable go ahead. If not do not suffer all your life as doing anything that does not make you internally happy is a great distress that might drive one crazy as also make one a patient even. Make your work your play and you enjoy life.
Many systems of medicine being practised in the world:
Whereas modern medicine takes the cake in the field of medical care delivery, it need not be the only or the best. There are equally good systems of medical care that need to be scientifically authenticated. Efforts are on all over the world to do just that. Recent audits have shown that modern medicine, which uses the wrong linear mathematics as its base is slightly off balance like the Tower of Pisa. Prohibitive and ever increasing cost of medical care in the present corporate hospital set ups, the unacceptable dangerous side effects of the multitude of drugs used today and, the clear evidence of over diagnosis and over interventions have resulted in patients looking for avenues elsewhere. Unfortunately, as of now there are no guidelines for patients to use the complementary systems scientifically. Every system of medical care, of which there are plenty all over the world, led by the ancient Indian Ayurvedic system, seems to forget that they need to update their methods using the modern scientific methods of testing.
Recent estimates of the very high budgets of complementary medicines in Europe and the USA have induced many players to come forward to authenticate those systems. Sooner than later it will have to fructify. The future of modern medicine might be confined to emergency care and corrective surgery at the most. Medical education in India is crying for reforms but the tardy pace of the governmental jaggarnaught moving and the money power of the vested interests are hampering those effort. It has to happen soon for the good of mankind and the profession if the latter has to survive in the present day world. Paternalism in medicine has to give way to partnership in medical care where the patient takes a keen interest in his/her treatment. Literate patients today could get access to most of medical information on the internet and the former have become vocal about their role. This is good augury. It becomes incumbent on the good doctor to transform those informations to knowledge and finally to medical wisdom to succeed. Novice will find it very difficult in this jungle of information to get at the rose wood. S/he needs a good guide to do that. That is the pivotal role of a teacher in the medical school. The down side of that is the defensive medicine that the star performers use today to save their skin. Defensive medicine turns out to be exceptionally expensive as all the tests are done for all patients irrespective of the need.
Medical education must move from the four walls of the class room of a tertiary care hospital to the community where the student gets to see diseases naked. In the teaching hospitals the student gets to see the filtered lot of chronic, serious and incurable diseases. The latter are a microscopic minority of diseases in society. Lest the student should get a distorted version of the disease prevalence in society the teaching has to be in the community. Only one medical school in India does that and that is the MGM College in Wardha. They are also advanced in that they have seen that all out patients are first managed by the Community Medicine department in the hospital and the specialists come into the picture only when their services are needed, avoiding thereby unnecessary suffering for patients with minor illness syndromes. The latter form the bulk of the sick population anywhere in the world. This kind of new approach is seen in many foreign medical schools. Surfeit of specialists is a bane of medical care arena as is clearly shown by a 14 industrialised countries survey of health status and medical care published in the leading American journal, JAMA (2000; 284: 483) This study, Is US medicine the best in the world will be an eye opener for all entrants to the medical college.
The biggest disease:
Poverty is not only the basic cause of all diseases in the world ranging from common cold to cancer, poverty is the largest disease load in the world. Not knowing where one’s next meal comes from is the greatest risk factor for killer diseases like heart attacks and caner! While there are about 39-40 million AIDS patients in this world, about whom you hear and read every day, there are 840 million who are malnourished and another 540 million live on a meagre income of less than a dollar a day. These are our real heroes looking for good doctors to do something about them. 6000 children die daily in India due to the complications resulting from malnutrition. India has the largest number of malnourished children in the world, a total of 67 million in all. This is much bigger than the total load of such children in the whole of Sub Saharan Africa!
With all our governmental efforts in the last one decade India’s load of malnourished children fell from 47% in 1997 to 46.4% in 2007! What India needs for its health are the following: clean drinking water for all, three meals a day uncontaminated by human and /or animal excreta, avoidance of hookworm menace with toilets for all, avoidance of cooking smoke coming into the house in villages containing deadly carbon monoxide killing children and mothers in large numbers, economic empowerment and education of women, nourishing mid day meal for all pregnant women to beget healthy children, good family welfare schemes, primary education for all, prohibiting alcohol and tobacco-the two deadliest enemies of good health and, employment opportunities for the able bodied. Unemployment is a big risk factor for killer diseases!
While you would read about AIDS, heart diseases and diabetes daily in your news papers and you get to see illustrated medical star performers eloquently championing those disease managements, no one ever talks about the greatest disease-poverty. When you become a good doctor and a star performer please help the poor. God will bless you. Serve them and you will be rewarded. India needs a new medical care system which combines the best in emergency care and corrective surgery from modern medicine and the rest of the 90% patient population to be able to get well using the selected authenticated methods in the complementary systems of medicine to do most good to most people most of the time.
Ayurveda and homeopathy are also good systems if one wants to study them scientifically and then get into research to take knowledge forwards in those areas. You would be the pioneers. Your parents might not encourage you there as they would think that your social status might not be the same as modern medical doctors. Truth is otherwise, though. West is looking to Ayurveda and other systems to lessen their unnecessary financial burden of the top heavy modern medicine. Before you take your seat in the counseling table try and see the movie SICKO if you can. Good luck to you all. Try and get what you want but after that do all that you can to take knowledge forwards in that area for the good of mankind. What changes is progress and that which does not change becomes dogma. May the medial profession get its due place in society as in the past where doctors were looked up to as God incarnates!
“Life is a school. Those who learn to love and help others graduate with honors.”
Anon.
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