Balanced evaluation of Medical practice

My dear colleagues, firstly I am not trying to patronise, act smart or disrespect anyone through this post.
Since so much is being said about antipathy of society, Government and others against doctors., hence there are few hard hitting facts which we as community of doctors need to introspect. These points are not applicable to everyone and some of you may criticise hence I will apologise to anyone who feels offended by this post in advance.  Some of you may feel that I have made assumptions in few of the points but if think from unbiased approach things mentioned will make sense—
1. Who allowed non- medicos to run a hospital and become administrators dictating terms of service to doctors??
2. Who accepted to become brand ambassadors for Pharma companies to promote their products ?
3. Who accepted to prescribe drugs of certain brand on recommendation of MRs and pharmacy selling those brands??
4. Who accepted to be sponsored by Pharma companies to attend conferences?
5. Who continued to do private practice inspite of being working in a Government hospital, drawing NPA and not allowed to do private practice?
6. Who diverted patients seen in government hospitals to private practice to earn money?
7. Who tried to belittle one’s colleagues  so that we can retain patients??
8. Who agreed to act as ghost faculty in medical colleges during  inspections for recognition of these colleges??
9. Who accepted freebies offered by Pharma companies to serve the personal gains of these companies.
10. Who agreed to follow instructions of administrators of medical colleges to pass students because these students had paid hefty capitation fees to get admitted in these colleges and hence need to be passed at any cost?
11. Who agreed to conduct free medical camps by few corporate hospitals to increase patient footfall.
12. Who agreed to conduct full body checkup with a battery of investigations (which are unscientific) to source out patients for corporate hospitals?
13. Who agreed to waive of patient fees to retain patients in ones care to make it affordable for patients??
14. Who allowed to fix ridiculous  pricing of disease treatment in packages in Government schemes.
15. Who agreed to get involved in illegal renal transplant rackets?
16. Who agreed to over treat patients with unscientific surgical procedures just to increase the cost of treatment?
17. Who wanted to continue being  given the status of god inspite of doctors being included in CPA?
18. Who has continued to treat residents as non-entity ( although this trend is changing) in medical colleges as they continue to work in inhuman conditions?? How many of us taken up their cause when we have reached a position where we can make some difference?
19. Who has at times agreed to do things and act as per whims and fancies of politicians??
20. How many of the professional bodies of various specialities have been proactive in formulating guidelines and protecting the interests of their members in difficult situations?
21. Most of are good in our specialities, but have kept up with changes  occurring in the social fabric.  How many of us try to keep abreast with knowledge and read literature to understand the changes occurring in the practice of our speciality.
22. We cannot remain aloof from the changes happening in the society and want the society to continue treating as Gods.
23. We have failed to understand that since the time of inclusion of  medical profession in CPA, we too should have changed the way we see patients and what to expect from the patients
24. There are many other factors too which also need to be thought about.
25. We need to understand that general public  will never come out in support of doctors because of varied reasons .  And doctors are a very small community as a vote bank for politicians to think about us .  Also it is irrelevant comparing ourselves to other professionals and crying that we as doctors are being victimised and our concerns are not being answered. The politicians have a larger vote bank to think about and doctors don’t matter to them in larger scheme of things.
26. We all are part of the same society with moral fabric we all know .
27. My take is consider every patient as potential litigant and treat patients accordingly with whatever best knowledge on has of the disease he  has come to me for treatment.

Enjoy what you do. It is possible in the medical field.

Dr. YK Amdekar writes that it is possible to be rational in medical practice if you set a goal to achieve it. It does not take time and with repeated practice, it becomes a habit. It offers satisfaction to a patient, happiness to a doctor and promotes good health in both.

What is rationality?

Rationality refers to judicious and well-reasoned sensible use of resources to offer quality service. Judicious use of resources in medical practice simply means minimal intervention (investigations and drugs) to get maximum benefit (cure if possible, comfort always).

Quality service in medical practice implies holistic care. Holistic care is possible with the use of all modalities endowed upon humans by nature – body, heart, mind and soul.

When translated into medical practice, body is knowledge, heart is compassion, mind is commitment, and soul the conscience. If it is done with devotion, love and loyalty, it becomes divine and it is so sacred that it helps with ultimate healing.

Medicine and rationalism are inseparable

Medicine is the most touching science of all. It involves healing, caring, soothing, reassuring, understanding, and offering hope. Medical practice should be a perfect combination of science and art. Rationality of science involves detailed history, keen observation (it is well known that eyes don’t see what the mind does not know), focused physical examination, objective reasoning and analysis, introspection and learning from your own mistakes. Rationality of art includes empathy, compassion, communication, counselling, and documentation. It is only when judicious use of science and art is combined that rationality is served.

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Universal pitfalls in medical practice
There is not enough time spent on detailed history. Proper information is not sought because of lack of time – it is an excuse. Whatever information is obtained is not analysed and interpreted due to lack of thinking. Once this habit is stuck, thinking itself becomes a disuse atrophy. This leads to unfocused physical examination likely to miss abnormal findings. It sets a vicious cycle of unnecessary tests, empirical therapy often with multiple drugs. It is obviously not conducive to communication, counselling or documentation. This is irrationality at its height. However it may still work and give a false sense of competence to a doctor. Unfortunately, the patient may not know about the poor quality of service but the doctor should introspect.

How to ensure rational medical practice?

Care always: For whatever complaint the patient may come to you, offer advice on preventive health issues such as growth monitoring, developmental screening including vision and hearing, ideal diet, proper hygiene and lifestyle.

Use clinical skills: Try to arrive at provisional diagnosis by analysis of detailed history and focused physical examination. Order investigations only after provisional diagnosis and that too if necessary.

Be a good listener: Every parent of a child or child himself may give you a clue to a diagnosis only if you care to listen to them carefully and allow them to express what they wish to say. Most illiterate persons also know enough to express though one may have to filter out what is not relevant.

Test a test: Before you order a test, think of ways such a test would help you to arrive at a diagnosis. Don’t order a test because you don’t know probable disease and so you don’t know which tests to order. There are no routine tests.

Be a rational prescriber:

If you don’t have any provisional diagnosis, decide whether it is safe to wait for disease to evolve. Empirical therapy is justified only in serious situations and that too after ordering relevant tests. Prescribe minimum number of drugs. Symptomatic therapy is necessary only if symptoms are very discomforting to a patient.

Communicate, counsel, and document: Inform the patient about his illness and therapy in simple words which improves compliance of treatment. Counselling is an art that guides the patient to go through his illness which instils confidence in a patient. Document in brief relevant facts that signifies transparency and accountability. It also helps to be legally safe.

Choose your own way
You have to set your own goals in practice and pursue them. Let your goals be professional credibility, peer acceptance, and social respect. To achieve this goal, be rational in practice and once you adhere to rationality, it becomes a habit that is sustained throughout life. It may take time to begin with but spending time for rationality is worth it. It leads to happiness and promotes your own health.

Correct and incorrect

From whatsapp
just saw our PM addressing ISRO scientists after Chandrayan 2  missed landing and it was an exemplary show of his leadership qualities....
he was awake till midnight and addressed those disappointed scientists at the time of need...
he shook hands with each scientist and at the end he hugged Mr Sivan n all were in tears.. wat a priceless moment!!! we r lucky to have such a leader!!
We r really proud of ISRO n our PM
At the same moment a thought disturbed my mind..
After 10 yrs of efforts by more than 700+ scientists vikram cudnt walk on moon surface none the less orbitor is doing its job.. great..
afterall disappointment is a feeling..
it is a human expression for failure..
all of us witnessed it on ISRO scientists today

this is the same feeling for an operating team when  we loose a major case in postop/ intraop even after working hrs n hrs meticulously...

this s the same dissapointment for a neonatologist when he looses a case of premature baby after 5 wks of nursing

its not different for neurologist wen he looses a case of status epilepticus  after all the care

it s same for a physician in PUO

it s same for an intensivist on a regular basis

and i think it s much more for an anaesthetist for on table death..

this s wat v r crying all these days that these are all not failures..

wen  a task of 650 cr budget .. 700+  scientis.. 10+ yrs can go wrong at penultimate moment...

the so called failures can also happen in medical field..

medical field is much more complex than space science....

we dont expect applause for our daring decisions to handle complex cases...
we just expect  an element of trust.... if not from law makers at least from our patients