Hey Doc!

An open letter to Indian Doctors

Trust. Admiration. Respect. Over the course of my life, you’ve given me ample reason, and then some, to associate these words with your good self. I’ve seen you make large strides in honing your skills, enhancing your knowledge, improving your techniques and pushing the length and breadth of your abilities. God only knows, that in a country of a billion plus people, we’ve needed you to do just that. And though I completely realise and accept it’s not an easy ride, the bumps along the way seem to have created a chink in your armour. And for whatever it’s worth I’d like to call it out fair and square.

Amongst the multitude of reasons that might have prompted you to take on the burden of being the hand that heals, one, I’d like to believe, was at least somewhat in the vicinity of being compassionate. There would have been others, far nobler ones as well, I’m sure, like using the best of your abilities to ease the pain, to reduce suffering, to fight the Grim Reaper when he tries to knock down some doors.

But compassion would’ve had to be the one that started it all for you.

Money, fame, power and other incidentals are bound to play a part in any profession. Noble or otherwise. We are all humans, after all. All of us need to make a living and most of us are ambitious. To hold a grudge against anyone, in any profession, for wanting some of those drivers as life motivators would be grossly unfair. I, for one, completely understand that.

And so, all I’d like to talk about, a wee bit more, is compassion.

I think it started off well and your intentions were spot on. Come to think of it, maybe those well meaning intentions have still not gathered escape velocity. The king has not yet left the building. I sure hope so, mate. Otherwise, this is a complete waste of a letter, isn’t it?

Coming back to the chink, here’s what I think has been happening.

Your profession is now more of an industry. The medical practice is being run like a business. Nothing wrong with that. Nothing at all. Before that being the case, we had minuscule privately run medical facilities and the state funded institutions were bursting at their seams, not being able to provide the infrastructure to support the needs of a populous and developing nation. The new setups were a breath of fresh air with clean rooms & corridors, seemingly better equipment and somewhat superior facilities. All this coincided, logically, with an improving economy, increasing income levels and a burgeoning somewhat affluent middle class.

The demand was there and so big investments started to pour into the sector. And investments demand returns. Once again, nothing wrong there. Except that, somewhere along the line you were roped in to generate those returns for the investors. In some cases, increasingly so in the last few years, the lines began to blur between the investors and your own lot. At the cost of fucking repeating myself, nothing wrong with that as well.

My goat’s with what happens to you in the midst of all this.

You take the money. You collude with the administrative set-up, the big pharma and whole ecosystem. You inflate requirements, investigative procedures and costs. Even if you don’t do it directly, you allow for the whole set-up to function in that manner with your complicity. You don’t really have a choice. It’s pretty much the same everywhere, every facility, every big medical institution.

The big overhaul that’s required, the one that will bring some degree of accountability is still some years away.

And you somewhat begin to dislike yourself a little.

Because along the way, shortcuts are taken. You begin to see negligence around you, mistakes being made. You learn to look the other way. Sometimes, you make a mistake yourself and others reciprocate. You dislike yourself some more.

You’re left with no choice but to rush through your day. Spend less and less time with each case as more and more enter through the funnel. There is pressure, no doubt there is pressure. The pressure of being true to yourself as a medical practitioner whilst also being one that’s adding value to the set-up. Economic value. It is not easy. Not at all. You can’t dislike yourself any more than you already do. It won’t be good for your mental health. So you become thick skinned, condescending and rude.

Patients are no longer human beings with ailments and suffering but a case ID. You forget that part of your hippocratic oath that says ‘there’s an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug’.

Without that compassion, without the warmth and understanding, you stop feeling for those you are treating. You stop listening, you cease to make any attempt to understand nuances of pain and/or discomfort. You are not too fussed about alleviating pain, leave alone the accompanying anxiety and restlessness. And God forbid if one is in a serious medical predicament, you start treating just the disease and not the human. And maybe not even that in a manner you should.

Some of this will need to change. And you are the one who needs to lead the change. Keep that compassion alive, bring it back right upfront and it might just get us to a state better than the current, if not where we need to be.

Hey Doc, your diagnosis is not terminal. There is hope. And even if I’m not holding your hand, I’m rooting for you.