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Is the present medical education relevant to our needs?

INDIAN MEDICAL education has undergone very little change since its inception in 1857 by the East India Company in Madras, Bombay and Calcutta. Our new doctors do get a reasonably good western type of education within the four walls of the medical college hospitals where only 0.01 per cent of the filtered sicknesses is seen by the students. Today a newly qualified MBBS doctor is incapable of practising medicine in a village all by himself. This is due to their paucity of understanding of the minor illness syndromes in the community and the total dependence on hi-tech gadgets for diagnosis that are lacking in a village!

We must change our medical education to train basic doctors that are capable of practising medicine without the hi-tech, self-defeating systems of diagnosis and management. A small per cent of patients would need that kind of medicine. That could easily be done in a few hi-tech centres specially reserved for this kind of patients. Ninety per cent of the patients would do well without hi-tech.

The highest technology needed for universal patient care is the kind words of a good doctor that stimulate the patient's immune system. It is the immune system that heals and not the drug or the surgery that the doctor performs. A humane doctor has a placebo effect on the patient's immune system. The future medical training must be such that the young doctor feels confident to make accurate diagnosis and arrive at management protocols based on his bedside skills alone.

Our status quoist attitude has killed innovation in medical education in India all these years. Time has come to ponder over what we do or do not do for our patients in the present modern medical hi-tech based system. A quick audit of the present system would show the lacunae.

AIDS and cancer deaths are on the rise. Doctors striking work recently in Israel, years ago in Los Angeles county and Saskatchewan in Canada, has had a good effect on society. Screening apparently healthy people could be very dangerous to human health and happiness. Most, if not all, drugs used on long-term basis in chronic degenerative diseases have resulted in more people suffering and dying compared to those helped by the drugs. There has never been a proper study done on drug combinations in science. While studies were done on single drug in ideal laboratory conditions, in reality, multiple drugs are used for patient care in anything but ideal situations. Patient compliance is so poor that one wonders if patients are alive because they do not take drugs in doses that are prescribed by doctors! To cap it, modern hi-tech medicine has become prohibitively expensive.

Doctor is trained to look after the health of the public. Doctors are not trained only to intervene with quick-fix methods when the human machinery fails, although the latter is very important for the individual concerned at that point in time. Time and energy spent to keep the public health would lessen the need for expensive quick-fixes in the long run. Our medical education does not stress on public health. Clean drinking water for every citizen; toilets in every house, cooking smoke free houses in the villages to avoid cancer and heart attack deaths in women and pneumonic deaths in children below the age of five years; a damp proof house to avoid bacterial infections; and economic empowerment and education of women to improve infant and maternal mortality are vital in this effort. Time has come to change our medical education and supplement the western knowledge with Indian wisdom of yore in Ayurveda and other systems of medical care to do most good to most people most of the time.

We need a cadre of basic doctors to man our family medicine facilities in towns as well as in our far-flung villages. We also need a small number of specialists and sub-specialists to man our hi-tech set-ups. The whole course of study, from day one, should be patient centred and community based. Classroom teaching should be minimum and an occasional didactic lecture could clarify some theoretical points. The grading system of evaluation with semester credits should be the foundation of evaluation. Keen bedside observation and trying to unravel some of the clinical mysteries should form the basis of clinical research in medicine. Refutative research to demolish many myths in medicine is the need of the hour.

The students should live and work with the practitioner for a year before graduation. Care should be taken to see that the basic doctor is not financially inferior to the sub-specialist. This is one of the reasons why our young doctors despise family medicine.

B.M. HEGDE

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