FEATURE

When society loses its sense of shame!

The release of A Raja, the erstwhile telecom minister accused of corruption on bail and the related news, revealed the depth to which we have descended. He was given a hero’s welcome befitting someone who won an Olympic gold and in the evening of his release, the report suggests that there was gala party with lots of fanfare at his house where hundreds participated. Couple of years before, when the Chairman of Indian Bank was arrested and taken to jail he waved to the crowd as if he is a freedom fighter taken in by the Britishers.

Kalmadi has his posters all over Pune and other accused in several scams are given coverage on television and in print media as if they are icons including their eating habits/reading habits etc.
There has been an explosion of modernism or, to quote a TV anchor, “the sublime assertion of modern thinking” in the last few years. One was the celebration by homosexuals after the Delhi High Court ruled that homosexuality is not a criminal activity. As if society anytime considered it criminal. Society considered it a mental case or perversion, but never criminal.
But the queer crowd had their parades; they re-christened themselves as LGTB (Lesbian-Gay-Trans-Gender and Bi-sexual), dragging in even the bi-sexual as fellow travelers. They claimed to belong to a minority and demanded human rights. Our 24-hour ‘breaking news’ TV mafias and main stream media (MSM) jumped into the fray. Incidentally gays are called MSM, Men having Sex with Men, the same abbreviation for our incredible main stream media.
For a few weeks, it was made to appear that being gay is the most virtuous thing, and if a girl is not lesbian she is missing out on something profound. I do not know how many TV anchors or MSM of the news variety editors would encourage their children to belong to that exalted category of LGTB.
It was bizarre to the core and revealed the slow but sure development of putting shamelessness on a pedestal and worshipping it. Homosexuals were always present in India even before Macaulay made them criminals by Section 377. But who cared? People may giggle but nobody was arrested being gay. Society treated them with the indulgence appropriate to such a category. Shyness prevented society from castigating them. Nor did it punish them. Christopher Isherwood was alleged to have been a homosexual. He was not berated for it. One of his friends in Calcutta reputedly jocularly commented to him not to entice young Bengali boys. Christopher was an erudite scholar associated with the Ramakrishna Mission; his works on the Upanishads are highly rated. The point is that he was neither glorified for his sexual orientation nor berated.
For instance the other MP arrested with A Raja is Kanimozhi who is referred to as daughter of Karunanidhi even though he never married her mother. Strictly speaking in the old world tradition she is illegitimate and so is Rekha who took oath as Rekha Ganesan. Gemini Ganesan never married her mother Pushpavalli. But as they say in USA that illegitimate is new normal.
Abhishek Manu Singhvi was alleged to have indulged in sexual act in his official chamber with an advocate and supposedly promised to make her a judge. He is still a member of Rajya Sabha and only social media like Face Book and Twitter exposed the so-called deviant behaviour while as main line media and other politicians kept quiet.
The second is more bizarre. There was a cartoon pornographic portal which portrayed a lustful and ever sexually indulgent lady called Savita Bhabhi. She was always having sex with assorted groups like door-to-door salesmen to neighbourhood kids to fashion show referees; the site was located in London. Its owner came out from his assumed name of Deshmukh to the real name of Puneet Agarwal. When his real identity became known, his family and community were aghast and he was forced to stop it.
Pritish Nandy, writer and film producer, wrote in a national daily that “Savita Bhabhi is a symbol of freedom, of empowerment, of the sexuality our women can wield if they are allowed to escape the sham world we Indian men trap them in because of our own fears of sexual inadequacy masquerading as machismo.”
Adman and TV commentator Suhel Seth added that “the fact that she was called ‘Bhabhi’ indicates a perverseness that always existed (in India) but we were in denial about.” This is the level of our mental bankruptcy and moronic approach to any social issue. There are many more of this type parading as intellectuals and social activists. These vultures are for the philosophy of anything goes. It is for the TRP and not for any value system.
The family of Puneet Agarwal itself felt that he cannot do just any business just to get a return on investment. That man was shamed by his family and community, but the TRP crowd was in a nauseating brawl with government, regulators and all types of societal values, oblivious that they were shaming themselves.
This trend started with the former Minister of Child Welfare (Renuka Chowdhary) starting a movement to fill up pubs with young girls as some girls were attacked in a pub in Mangalore by some fringe elements. The print media and TV, particularly the MSM variety, made a big issue of it and encouraged young boy and girls to go to pubs and drink. Drinking was made a virtue in the name of freedom and right.
Indian society is accommodative and understands the complex of human nature. It does not insist on linear behaviour. The supercilious have made a grave error of superimposing Western debate on Indian society.
We think that when shamelessness is equated with freedom and modernity, there is a need for transparency and full disclosure. The denizens, anchors, editors, and correspondents who parade such shamelessness as sacred should disclose whether they belong to such category? Whether they are from happily married families or from broken families? Whether they will encourage their wives and Bhabhis to behave in such fashion since it is a symbol of freedom?
They should also disclose their love life, family life and children who go to school and provide information if such “freedoms” are encouraged and provided to them. If not, others will put it in the public domain. These anchors and editors cannot get away from personal responsibility and personal behaviour when they speak of societal norms.
It is high time our social media at least expose these vermin who are out to peddle poison as freedom, and perversion as sacred. Let us understand the importance of shyness in some situations, and appreciate silence in many situations. There are still concepts of virtues, shame and perversions, and let it not be forgotten in the TRP race.
(The author is professor of Finance at IIM Bangalore-Views expressed are personal)

Bedside Medicine- A Forgotten Art.

“One kind word can warm three winter months.”

Japanese saying.


“Art” wrote, Henry David Thoreau, “is that which makes another man’s day”. One kind word on the bedside can cure many ills. The art of medicine is that which should make the patient’s day. In fact, the summit of all efforts in the field of medical care delivery is the coming together of two human beings-the one who is ill or imagines to be ill and the other in whom the first has confidence. This is called medical consultation. All else in medicine should really flow from this summit. “Know your patient better than his disease” was the opinion of the father of modern medicine, Hippocrates. Having worked under some of the giants of clinical medicine both in India and abroad, I feel sorry for the patient as also for the doctors of today who think that the hi-tech investigations give them the diagnosis and management strategies.

Hardly anyone talks with the patients these days. Most of the big bosses make what they call the “chart rounds” in the ward side rooms where all the details of the patients, including the scanners and X-rays, are kept. Little time is spent on the bed side. The present jargon for good medical practice is “euboxic medicine” where all the right boxes should be ticked in the computerised case sheet. Whether the patient feels better or worse is of no consequence. “Patient doing well do not interfere” wrote Sir William Osler, a great clinician of the last Century. “God give me deliverance from-treating suffering human beings as cases, not letting the well alone, and making my interventions worse than his disease,” was the daily prayer of Hutchinson. If you talk to a present day sub-specialist, he/she would say that all those ancient timers didn’t have the array of scopes and scanners that we have today!

Recently a triple blind, computerized, prospective study was undertaken in London by some of the great teachers in different medical schools there-John Mitchell, John Hampton, Michel Harrison and Carol Seymour, to name a few of them- to study the role of listening to the patient and reading the referral letter from the family doctor vis-à-vis examining the patient physically and investigating the patient with all the gadgets including the positron emission tomography, in the diagnosis of medical out-patients. These giants were all students of Lord Platt at the University College Hospital London. Platt had written in 1949 that “if one were to listen to the patient long enough the patient would give away his/her diagnosis.” Platt’s students, who now have access to all hi-tech stuff, wanted to check the veracity of his statement.

This study was published in the British Medical Journal. The study showed, to everyone’s delight, that 80% of the accurate final diagnosis and one hundred per cent of the future management strategies could be arrived at, at the end of listening to the patient and reading the referral letter. This could only be refined 4% more by all the physical examinations and only 8% per cent by all the investigations including the PET scanner! A very strong message there from a very robust study, indeed. This will be a boon to all doctors ready to practice even in a remote village. Unfortunately, all our doctors are trained within the four walls of the five star hospitals where their teachers rely only on the modern gadgets. It is not a surprise that such doctors tomorrow will feel frustrated to practise medicine without those gadgets. The new trend is being propped up by the industry through their indirect advertisements under the guise of scientific data.

Every disease, in a manner of speaking, is “slightly mental”. Diseases start in the human mind and also end there. If one wants to get a grip on the patient’s problems one will have to have an inkling into the patients mind-his worries, his anxieties, his fears, his obsessions, his spirituality, his environment, his family ties and his problems-all of which will have a say in the final outcome. These important aspects of the disease management could only be gauged by listening to the patient. In his beautiful book Talking with Patients, Prof. James Calnan, who was Emeritus professor of Plastic Surgery at the Hammersmith Hospital, London goes to great lengths to show that “talking with” or listening to patients is an art that should be mastered by every medical student. (Calnan J: Talking with patients - a guide to good practice. William Heinemarn Medical Books, London. 1983. 151 pages.)

In our days we were to follow the foot steps of our teachers by observing how they talked to and listened to patients in the out patients as also on the bed side. This is absent in today’s atmosphere. That breed of teachers is almost extinct like the dinosaurs. Even the so called bed-side clinics are now conducted in what they call the ward side teaching rooms where another mini didactic lecture takes place on the patient’s problems! Real beside clinics should happen on the bedside where the patient could be observed carefully even while he is talking. His facial expressions, showing his internal turmoil, could be a pointer sometimes to the final diagnosis. Sir William Osler had a prescription for all doctors to have two great qualities on the bed side-imperturbability and aequanimitas- equanimity and the capacity not be perturbed under any circumstances on the bed side. These two, in their absence, could send wrong signals to an anxious patient.

Some of the important clinical research data in the field of modern medicine have emanated from the bed side. Genuine clinical research is nothing but a question on the bed side and the effort to go as far away from the bed as needed to get an answer! Some of my original works, reported in the prestigious journals abroad, have come from the bed side. Time spent by the students on the bedside will bear fruit in the long run to make them very good humane doctors. Every patient is another human being in distress and needs to be understood with compassion before being treated with drugs or surgery. A good doctor knows how to treat from the books, a better doctor would know when to treat from the books again, but the best doctor knows when not to treat from his bedside experience only. Our present biggest problem is over treatment, resulting in adverse drug reactions and over interventions.

IN conclusion, one could easily say that if one trains himself/herself to be a good bedside clinician one would have achieved great success in dealing with patients. One must learn to listen- a very difficult art, indeed. Medicine is basically an art based on the scientific foundation that seems to be shaky. If doctors have done any good to the suffering humanity that was mainly because of their bed side skills and not based on the faulty science of reductionism. “Cure rarely, comfort mostly, but console always” was the advice of Hippocrates and still remains valid to this day of hi-tech stuff. To practice each one of them the doctor must be a great communicator. Pain and suffering were the problems for our ancestors in medicine and they are our problems today and will remain the problems for the future generation of doctors as well.

So bed side medicine will remain the sheet anchor of medical management for all times to come. Time was when medicine was purely paternalistic where the doctor was considered God and he/she did what he/she wanted. Today it is gradually becoming more of an equal partnership where the patient takes part in his /her management. It is more important today to know one’s patient than it was in the day’s gone by-all the more reason why today’s doctors should be better bedside clinicians and communicators. Long live the fine art of doctoring.

“They also serve who stand and wait.”
John Milton.

to be contnd. in next issue...