July 1 was Doctor’s Day, observed in commemoration of Dr. B.C. Roy, national leader, freedom fighter, two-time Chief Minister of West Bengal and a medical doctor by profession, and who successfully straddled two high profile and demanding careers — politics and medicine.
When he was a practitioner, India was a poor country with very limited health care resources and deplorable human development indicators. Yet it was the time when a physician was held in high esteem, playing a pivotal role in the lives of his patients and ensuring their physical, social and emotional wellness.
Now, having successfully harvested the fruits of globalisation partly through a knowledge based economy, India is no longer poor, but a country in the lower income group category with significant improvement in the human development indicators over the years.
The predominance of the private health-care sector, the increase in the burden associated with non-communicable and communicable diseases and a demanding society are the complex issues a physician in the 21st century faces. He is no longer revered as the “friendly family doctor” but has to deal with his patients’ rising expectations of his professionalism.
Medical professionalism is the conduct of a physician towards patients and society.
The professional conduct of physicians has evolved over the centuries from the time Hippocrates wrote the oath. A doctor’s role now encompasses broader principles such as primacy of patient welfare, patient autonomy and social justice. However, the core values — compassion, ethical behaviour, altruism — are timeless and remain unchanged. Newer technological innovations, societal pressures, legislations by the polity, the perception of the health care system as an industry and various other factors have forced the physician from playing a sole role of a healer to that of a multipurpose worker: medical scientist, health educator, counsellor, health activist, and so on. In order to effectively participate in this multifaceted role and to bring about intrinsic social changes, a doctor is expected to work in cooperation with others in the system, without compromising on values.
Medical professionalism
Humaneness is the foundation for good professional conduct in a doctor. This has to be inherent in medical students. Fortunately, most students enter college as idealists, but the complex and sensitive nature of the profession may lead to disillusionment and resentment. The medical education system should create special training modules on ethics, humanism and professionalism so that young students can equip themselves to retain these values throughout their careers.
The medical profession is responsible for the most vulnerable section of society — the sick. The big investment that the sick make in physicians is trust. Therefore, the physician has to be truthful, benevolent, sensitive, and intellectually honest.
The challenges
The challenges to professionalism, values and ethics are many. The health-care system is undergoing major changes. Private players play a dominant role in both health care infrastructure and health education sector. Exorbitant capitation fees in medical colleges, an erratic selection system, and the dependence on the private health care sector for lucrative job opportunities may convert this humane institution into a cold, calculating, unfeeling corporate model.
On the one hand, doctors and other medical professionals in the private sector are under intense pressure to perform and increase profit figures by the new breed of medical entrepreneurs; on the other, the public health care system and the insurance sector want doctors to create cost cutting methods instead of striving for cost-effective modules of medical treatment.
The net result is that the vulnerable sick patient may not receive appropriate care. In an era where people — even the sick — are increasingly aware of their rights, this may result in patient blowback such as litigation. Certainly, there is case to be made for educating the common man that the health care sector is multidimensional; that for doctors to provide quality care, coordinated effort by all agencies concerned is essential.
But there is also urgent need for physicians to take a relook at their role. Most doctors strive hard to achieve professional competence despite a multitude of problems. But increasingly, the younger generation views the medical profession as just a job and not as a vocation. The answer may lie in doctors being not just caring, compassionate individuals but also embracing the role of vociferous health care activists. Doctors who are and who will be respected beyond their times, all over the world, are the ones who have embraced such activism, both challenging and working in coordination with the state to bring about positive health care reforms. The remarkable examples include the late Dr. A.L. Mudaliar, in the field of reproductive health, to Dr. V. Shanta, at the Adyar Cancer Institute, Chennai. We need more such dedicated activism for a better medical delivery system.
(The author, a practising obstetrician and gynaecologist, is a former Tamil Nadu Minister. E-mail: poongothaibalaji@yahoo.com )
