Wednesday, March 16, 2016

The Dwindling Humaneness Of Medicine - Dr Sunil Chandy, Director CMC Vellore

Imagine you are a patient and you have a long story to tell your personal physician. You make an appointment with him. He lets you into his chamber, asks you to sit on a side stool and tell him your history. As you narrate, he is rapidly typing on the keyboard hardly looking at you. He intermittently asks you to stop the narration for him to catch up with typing. He still does not look at you. At the end of the consultation, he hands you a set of slips, investigations, prescription and a bill. Your data has been very accurately entered into the hospital information system, archived forever and he can retrieve it at will. As you move through, the lab is ready to take your blood and the pharmacy has already packed your drugs. This conveyor belt experience in Medicine is today the standard of care - efficient, rapid and standardized. But ask yourself this question - how satisfied and complete would you feel if your physician did not establish eye-contact, examined you and touched you with his hands. This is how most patients feel nowadays, with gadgets, monitors and scans replacing the human being in the doctor-patient relationship.  Medicine has undergone three radical changes which challenge the humane-ness of medicine. 
Reductionism: The spare-part approach induced by the specialist culture has broken our whole body into several parts. It is as if  the body is a warehouse of several organs, stacked and shelved in compartments to be taken out by specialists to treat and fix it back. Like the digital boards in electronic devices. The headache-to-a-neurologist --chest pain-to-a-cardiologist practice has been to the detriment of the human body as a whole. The interconnectedness of organ systems that talk to one another in disease and in health has been forgotten. As a result, the poor patient runs from pillar to post spending all his money without his problem being addressed. Quite often, it may just be an infected pimple in the sacral region that escaped the palpation of the physician.  
Standardization: The clamour for SOPs, guidelines and protocols has de-personalized medicine. To everything there is an algorithm, we just have to dig it out on 'Up-to-Date' and apply it. Apps freely available on smartphones is making the resident 'unsmart'.  These quick-aids have obviated the need to think and apply scientific logic in clinical situations.  No two human beings are alike, not even twins, then how can we even think of standardizing clinical practice. The heterogeneity of clinical presentations is the challenge of clinical medicine. The mystery of a certain presentation and the nuances of treatment add up to the thrill of being a physician.  Sherlock Holmes would testify to this. The algorithm-driven practice  of today has completely wrecked the joy of being a clinician. And this explains the disinterest among young physicians today.  

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