Offlate, because of our book, we have been interacting a lot with medical students and that kind of pushed me into giving a thought to my own reasons about, “Why did I become a doctor?”
Well, whatever lofty reasons I may attribute it to now, 25 years ago I only had one reason, “I just wanted to prove myself”. This is what the academically best students did. They either cleared PMT (the equivalent of NEET in our times) or got into IIT. Nothing less and nothing else was accepted if you claimed to be amongst the intelligentsia within your peer group. Well, intelligentsia would also often translate into the boring, bespectacled, date awkward dudes and dudinis who needed to feel that all their sacrifices were worth it 😊. For me getting into medicine was the ultimate destination of my life at that point. Did I understand that what I considered as the ceiling of my life then, was just the basement of a huge multistory tower? The answer is a resounding NO. But I guess at 17 some degree of naivety is acceptable….& I guess, a lot of people will identify with the story till here.
I entered the medical school raging with the feeling that “Wow! I did it!”. I was a silly teenager who thought that clearing PMT and getting into medical school had already made me a doctor. Oh boy! Had I known how much hard work and grilling awaited me, I would have surely reconsidered. Well, the most striking thing about MBBS was “friends”. Back then, friends were my life and they took priority over everything else. It was all about mischief, laughter and late nights. Giggles and gossip was the order of the day. It was also about the hostel. As pathetic as it was, there was something about hostel life and we wouldn’t trade it for anything in our life at that point of time. Sometimes it was about dating too. Although back then we didn’t have cell phones and tinder but I guess, where there is a will there is always a way 😉. Later it was about getting through thousands of pages of medical literature. It was about learning the intricacies of those tiny little foramens in the skull through which our nerves came out, it was about marvelling at how the body maintained the delicate balance of homeostasis, it was about how babies found their way out of the mother’s pelvis and how life perpetuated itself. Nothing can be more fascinating than the biology of the human body unfolding in front of your eyes. Everything was so logical and so clear, except ofcourse during vivas when I would suddenly seem to lose my voice. Viva voce was usually Viva sans voce, atleast in my case!
Sounds familiar, isn’t it? Most of us have a similar story. At this point, I would like to pause and reflect a little….What did we learn in those 5 years? Undoubtedly, we learnt the “science of medicine” and we learnt it well.
We learnt that a cough could be URTI or it could be a result of acid reflux or sometimes a sinister sign of heart failure. A lump in abdomen could be hepatomegaly or lymphoma or a huge mesenteric cyst. What we saw during our training were cases to be solved, lumps to be diagnosed and exams to be cleared. During clinics, 15 of us would palpate that one case and have intense discussions about the diagnosis. It rarely occurred to us that lump was inside a person and that person was a patient and not just another case. In our zeal to master the science of medicine, the art of medicine was totally neglected. We begin our careers with a foolhardy belief that our ability to diagnose and treat makes us great doctors.
Then came internship. Right in the middle of our medical careers, internship is a phase of total identity crisis. Doctors by degree, we are just blood sucking, glorified couriers fetching samples and reports from one department to another. It’s also a time when the race for Pre PG NEET intensifies. As interns we rightfully wear the white coats but work like technicians…. Always in a hurry to get back to our books, aiming for that coveted score that would lead us to the choice of our specialization.
The question to ask now is- where is the doctor patient relationship in all this?
Do we even remember the names of those cases with lumps and murmurs? Do we know whether they are alive and well? Did we make an effort to find that out? We don’t need to guess the answers to these questions….
My first foray into doctor patient relationship happened soon after internship. I was posted as a house officer in a rural hospital and a 24 year old young bride came in with more than 90% burns. This was the first time I was responsible for actually caring for a patient. A young rookie, I put in all my efforts and diligently did her debridements and dressings for hours. We gave her the best antibiotics and she seemed to be improving. On the third day, she just died. Though I am a bit wiser now, it came as a shock to me then. Five and a half years of training in medical science had not trained me into accepting defeat and death. I was not prepared to realize that sepsis could be stronger than treatment and that a person who was alert and talking the evening before could disappear into oblivion the next day. I was not prepared to deal with my own grief and neither was I prepared to console the patient’s family. I would like to believe that 25 years into medicine and almost 15 years into clinical practice may have made me wiser and stronger. Unfortunately neither is the case. Doctors are not God and a 1% complication rate is a reality that cannot be evaded. Unfortunately our medical training does not focus on this 1%. This 1% that is statistically insignificant by medical standards is the 1% that matters the most, to the patients as well as to the doctors.
It is a paradox that we spend a decade in learning the science of medicine while it is the art that is the essence of medicine. Medicine is not so much about excellence as it is about empathy. Medicine is not about mere statistics, it is about real people. Medicine is not just about pharmacotherapy, it’s about relieving pain. Medicine is not about ticking forms, it is about connecting with people. It is about extending a helping hand when you may not be feeling so strong yourself. Sometimes it is about a gratifying conversation, a touch or a hug. Medicine is all about relationships and making them work. It is certainly not about “us versus them” like it is made out to be these days.
It is the need of the hour to engage young medical students and doctors into these conversations and show them a glimpse of what lies ahead. As senior doctors it’s high time that we start making efforts to mend the broken ties and put the pieces back together.
At the end of the day, medicine can never be just about treating. It is always about healing.