Looking Back.......

The society's viewpoint regarding the Medical Profession (doctors of various specialities,super-specialities,sub-specialities,the pharma industry,the diagnostic centres,the corporate multispeciality hospitals) has changed tremendously in last 40-50 years. It is due to the scientific advances,knowledge outburst on internet,influence of social media,political wills-wishes & nuances & overall development of the nation as such.

As a medical professional, a participant & a witness to all  this,when I look back,what I feel,I have analyzed & tried to pen down. It is my honest observation & is not meant to malign or harm anybody.

When I was young,there was no need to go to a doctor,as my father himself was a doctor. When I went to Akola for my pre-meds,in 1976,I had to go to a doctor for the first time. It was a well known general practitioner,Dr Sanghvi. He was famous for his short temper & used to believe in giving injections to each & every patient,but his treatment gave results for sure. Then there was a railway dispensary,where I used to go only to take a travellers medical authority to go to Bhusawal during the weekends. The doctors there,Dr Gajbhiye & Dr Tank,were my father's friends, so they issued the authority to travel for treatment at Divisional railway hospital Bhusawal.(for the disease I never knew.😄😄)

Then at Nagpur too there was no need to go to outside doctors,as we had joined MBBS course & the whole medical college was there to cater to our needs on a preferential basis. I lived with my grandparents in our Dhantoli house. There were two famous general practitioners in that region, Dr Pradhan & Dr Pendse. Both very famous,Pradhan being senior.Dr Pradhan was very soft spoken & a real family doctor. He used to know all the family members by individual names,knew their family problems too. His words were last & the entire family used to follow his advice as an order. He used to dispense medicines from a separate counter,manned by a compounder named Asaram. They used to give different coloured tablets plus cough & anti-fever syrups in a glass bottle with a sticker which marked the dose. Asaram continued the general practice for many years after death of his boss. People used to bring glass bottles from home to take cough syrups etc,to save 50 paise. Dr Pendse was very intelligent & very methodical,he too was very gentle,but a little curt. He was our not so distant relative & his son,Dr Sharad,is now a very well known diabetologist of central India.  Both these stalwarts were known for their clinical acumen & very popular in society.

Back home in Bhusawal,the era & aura of Railway hospital as the only hospital having specialists was gradually declining. The stalwarts like Dr.Harbola,Dr.Bhandari,Dr.Upasani were either retired or transferred & my father,Dr.Singh,Dr.Bapat,Dr.Thakare were holding the forte. Private practitioners Dr.Pradeep Naik,Dr.Surendra Bhirud,Dr.S.S.Mahajan,Dr.Vasant & Dr.V.N.Choudhary,Dr.Vijay Bhangale,Dr.Umesh Khanapurkar,Dr.Rajesh Gupta, along with the veterans Dr.Davalbhakta duo & Dr.Shinde the only anesthetist those days,were establishing very well.When I started practice at Bhusawal in 1988 as a general surgeon,there was a fine gentleman general practitioner,Dr Manohar alias Babasaheb  Khanapurkar,the most sincere family doctor I have ever seen. He truly was the most caring doctor. If he suspected some surgical problem,then he considered his duty to reach the patient to the concerned surgeon. He used to do a phone call to enquire,& if the patient went home instead,he used to visit his home to convince him the need for operative procedure & bring him along with himself. He used to do home visits too. His bag contained a stethoscope,a torch,a hammer(to see reflexes)many tablets & injections.The relatives used to boil the syringes to sterilize,using their home utensils.He had a green baby Austin car which used to be called a match-box jokingly. Then there was a senior physician,Dr.G.P. Bhagwat,who was very intelligent & was very handsome too. He had an ambassador car of light grey colour.His charges were very high by that time standards. So,people used to call him only when the patient was very serious. He was also famous for getting called to declare death of a serious,ailing patient,so whenever people saw his car standing in front of any house,they used to  start for the funeral procedure.😄 His son,Dr Rajeev is now a famous cardiologist at Nanawati hospital,Mumbai.

Those were the days of real general practitioners & only a few specialists.Bhusawal had Dr D.G.Patil,Dr.Pramod Choudhury,Dr Chandwadkar,Dr.Kader Khan & Dr Pardesi as MBBS general practitioners apart from Dr Khanapurkar I just mentioned.

 The general surgeons used to do all sorts of surgeries like paediatric surgeries,urologic procedures,gynaec surgeries,plastic surgeries,fracture & orthopaedic procedures & even Tonsils. Getting tonsils out was a fashion then & was considered as a stimulating boost to the  children's growth. Summer & Diwali vacations,all the surgeons did at least 4-5 tonsillectomies per day. To tell you the truth,my first surgery after starting private practice was too a tonsillectomy.

The physicians too treated all kinds of medical diseases from malaria-typhoid to diabetes,heart & kidney diseases. That was the era of real clinical diagnosis & less relying on investigations (They were not available too). That era was an era of full mutual faith & trust for both,doctor & patients. 

The Drug industry was also growing fast & few Indian companies like Cipla,Ranbaxy,Dr Reddy's lab,Nicholas Piramal were giving tough competition to the multinational giants like Glaxo,Novartis,Smith-Kline,Merck,Johnson & Johnson etc.There were good intelligent,learned medical reps who passed on the recent knowledge to the doctors as there were many  newly invented drugs not in our curriculum when we studied pharmacology in second MBBS,also,there  was no internet like today,where you get everything on just one click.  Some pharma companies were famous for their gifts like new year calender, diaries & pens. It was a matter of pride to receive these gifts with our names engraved on it. Usually these medical reps were locals & we used to prescribe the quality product at a reasonable price,but personal relations mattered the most.The Indian Medical Association Bhusawal was very active & there used to be monthly family meetings with guest lectures & dinner sponsored by one of the members.The comraderie & respect for each other was & I am proud to say still is,very good. Overall,it was great fun working.

Then came the Consumer Protection Act. It changed the whole scenario. Doctors went on backfoot,every patient was looked upon as a potential suer, unnecessary investigations like many blood tests,CT scans,MRI,referral to specialists & super specialists rose to a high level. The divine doctor-patient relationship was getting transformed into a dry, seller-consumer pattern. At the same time,due to political vested interests,private medical colleges boomed,high capitation fees became standard,resulting in very high investments to become a doctor. These new specialists & super specialists then resorted to giving cuts-commissions to the referrers to survive & to grow. The pharma industry also was growing tremendously,taking advantage of the process patent law, making cheap off patent copies of new drugs. What was available for say Rs 1000 in western countries,same molecule they made available for say,Rs 100.(but this was also high as per Indian standards that time) There was a cut-throat competition in pharma industry & the gifts of pens & diaries were replaced by sponsoring foreign tours for  conferences. The doctors started defending this  under the cover that they too were humans & had personal families & needs to cater to.Overall the morality had started descending.

Now,the positives :

Due to change in import duties & policies by the Government,all the newer advanced equipments could be bought with ease. We saw a boom in CT scans,MRI machines,diagnostic pathology auto-analysers,newer sonography machines,Gastro-colonoscopes,cysto-resectoscopes, laproscopes,operating robots,mammography machines, Cath labs for angiography-plasties etc.

Cancer detection was made easier enabling curative surgery-radiotherapy-chemotherapy possible. Heart attack patients got a new lease of life due to early detection by stress test,angiograms & treatment by stents or bypass surgeries. Laproscopic surgeries made the patient walk out of the hospital the same day & resume work back in a couple of days. Ulcers were treated successfully medically by the drugs without the need of major surgery,documented by serial endoscopies. Complex kidney stones were fragmented & pulverised with lithotripsy,prostate operated without a single stitch. Critical care centres helped the survival of many sure shot goners! 

There was a boom of multispeciality hospitals & everything was made available under one roof. India became a centre of medical tourism offering world class treatment & an opportunity to visit the Tajmahal at an affordable price! The medical council of India too has warned the doctors to keep their knowledge updated by attending continuing medical education workshops,to collect points thereof,necessary to renew registration every five years,a welcome move indeed(if implemented properly of course!)

The only hitch to my mind is,that this benefit of scientific advances is not being passed to the common poor man(which constitute nearly 70% of Indian population) because most of it not available in Government hospitals. The poor common man has to go to private hospitals. The private hospitals too have big investments in all these state of the art facilities,their maintenance cost is also very high. So,howsoever less they try to charge,it is still beyond the reach of common man. This is the cause of anger & attacks on the doctors & hospitals.

To me,the solution lies in the government allocating more budgetary  money to healthcare sector making government hospitals fully equipped & adequately staffed & providing mediclaim insurance cover to general public which the current government seems to be doing. There should be more Government medical colleges  to produce more qualified doctors improving the doctor to population ratio.

Also,good general practitioners or family medicine doctors should be available everywhere & people should be made aware to consult them first for any problems,instead of going to specialists or superspecialists directly.

To sum up,the medical profession still is the noblest profession & the best opportunity God has given to serve the needy. I don't & never ever regret  choosing this profession inspite of facing some rough patches down the road. And,the answer to the question that would I like my children to choose medical profession is : A BIG YES!