While medicine remains central to public health, medical academia has never been a torch-bearer for the public health cause. Apart from the inherently individualistic character of medicine, part of the reason can also be located in Indian medical education originally “carrying the cultural accretions of the West”, as D. Banerjee puts it. Multiple policy deliberations have upheld the idea of training a socially oriented physician responsive to community and public health needs. However, a deficient social emphasis is still a stark feature of India’s medical curriculum.
This orthodox edifice of medicine has come under attack thanks to the COVID-19 pandemic , which is both a medical and a social calamity. The pandemic has served to water down the elitist and individualistic barriers of medicine that have hitherto kept apart the private and the public, the rich and the poor, and the individual patient and the community. COVID-19 has delivered one strong message: when it comes to a nation’s health, private care is of public concern, and public health is of medicine’s concern.
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Creating ripples at the societal level
Early this year, there were debates on why elite professional institutions such as top medical colleges rarely become the centre of political ruckus and remain free of strong ideological leanings, unlike many of their humanities counterparts. The perception about medical academia is that it is too preoccupied with cultivating scientific and professional excellence to cast an eye upon politics. One reason given to explain leftist dominance in humanities academia is the keen social orientation that humanities education inculcates. By the very virtue of their education, humanities students feel strongly about inequity, stratification, and deprivation. This element remains missing in technically oriented, competition-driven professional fields such as engineering and medicine. But while engineering is irredeemable in this respect, the same cannot be said for medicine. Both the number and profundity of emotional experiences that medical college-hospitals see on a regular basis can scarcely be fathomed in any other category of educational institution. The Competency-based Undergraduate Curriculum applicable since 2019 emphasises on inculcating communication skills and empathy in medical students to improve clinical practice. However, that such empathy can create stronger positive ripples at the societal level has been given little attention.
This is not to suggest that medical colleges must be modelled after the highly politicised humanities institutions. The idea is to emulate purely the ‘social orientation’ element. The same empathy shown at the singular-patient level, and which improves clinical practice, can manifest at the societal level to confront the inequalities and deficiencies of public health. It is common knowledge that public health has perennially been one of our highly neglected items. It is also a concern that cuts across party lines and stands little chance of being viciously contended and politicised. Besides, a deficient social orientation among physicians has significantly contributed to their maldistribution.
Remodelling the foundation
For this, the foundation of India’s medical education would need to be radically remodelled along bio-social lines. There is need of radically enhancing community exposure during both undergraduate and postgraduate years. For this, medical training will need to shift a considerable part of its base away from medical colleges in cities to lower-level health facilities and the community, along with seamless integration of medical colleges with the health services system. Also, there is need to pep up the community medicine curriculum and teach health policy to medical students emphasising particularly the sociological and political-economic aspects. All of this should confer the ability to critically analyse how health and medicine function in the bigger picture — creating a socially oriented physician capable of relating with macro-level challenges in public health apart from practising social medicine.
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Some might say that that the biggest stumbling block to realising socially oriented physicians is the commercialisation of the medical profession. But commercialisation is something that has largely arisen from within the profession. Given this, corrective measures will also need to be effected from within. The aforementioned measures can actually help us combat commercialisation among multiple others, given an environment conducive for the same. In the wake of the pandemic, we have started entertaining ideas such as private hospital nationalisation and mainstreaming of alternative medicine. A push for any reform cannot do without acknowledging the imperative of social physicians for better public health.
Dr. Soham D. Bhaduri is a Mumbai-based doctor, healthcare commentator, and editor of ‘The Indian Practitioner’
