Medical science with Shakespearean undertones
Binoy Barman appreciates a work doctors should love
26 February 2010, 18:00 PM
Essentials of Good Doctoring
Prof. Dr. Samiran Kumar Saha
Dibyaprakash
A common allegation against physicians in Bangladesh is that they do not discharge their professional responsibilities with a mind of service to humanity, which their profession is meant for. Maybe it is not applicable to all physicians but it is true of a large number of them. There are multifarious reasons for this. As a nation we lack a humanitarian service-rendering tradition; many physicians coming out of poverty-ridden families set money-making as their only goal in life; at the institutional level it is not ensured that physicians will come to patients' service whenever and however necessary; ethics of medical practice are not inculcated properly in a physician's mind; and a wave of capitalism has driven medical practitioners into a rat race for material gains. It is undoubtedly a sorry state of affairs.
Samiran Kumar Saha is well aware of the situation. So he laments the plight in the country when he relates it to ideal medical practice. He remembers Dr. Rieux, who dedicated his life to the treatment of plague patients in the city of Oran in Algeria, as depicted by Albert Camus in The Plague. He says: "Did we ever come across such a doctor in our society …?" It is a difficult question which flies in the face of medical practice in our country. Of course, there are great physicians like Dr. M. Ibrahim, founder of the Diabetic Association of Bangladesh, but their good image is overshadowed by the 'bad' doctors whose negligence to duty leads to patients' deaths.
The profession of a physician is undoubtedly a noble one, which implies great responsibility to ailing individuals. A physician must be caring, with sufficient knowledge of curing. "Tact, sympathy and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, and disturbed emotions. He/she is humane, fearful and hopeful, seeking relief, help and reassurance," observes Dr. Saha. A physician is a scientist as well as an artist. He/she knows the art of pacifying a patient psychologically as well as the science of eliminating diseases from his/her body. Almost axiomatically, medicine is the most scientific art and the most humanistic science.
How should the relationship be between a doctor and a patient? Should it be like master and slave, teacher and pupil, or lawyer and client? No, the relationship should be rather like that of friends, who talk to each other with sympathy. A doctor must patiently answer all the questions asked by patients and their relatives and adopt an agreeable way of treatment. He/she must be a good listener. Dr. Saha says, "To diagnose, manage and treat a person's disorder, physicians must have learned to listen." From a biopsychosocial perspective, a physician must not only have working knowledge of patient's medical status but must also be familiar with how a patient's individual psychology and socio-cultural milieu affect the medical condition, the emotional responses to the condition, and the involvement with the doctor.
A good physician knows the techniques of handling patients. The better a physician knows about a patient's beliefs, feelings and habits, the bigger is the chance of proper treatment. He/she must know how to deal with different types of patients: difficult patient, depressed patient, histrionic patient, dependent patient, impulsive patient, narcissistic patient, obsessive patient, paranoid patient, isolated patient, malingering patient, demanding and passive-aggressive patient. He/she should be able to read a patient's mind correctly. He/she utilises his/her good communication skills to elicit information about the patient's condition. His/her communication with the patient never fails. He/she negotiates passionately, shares knowledge and responsibility, identifies the real problem and gives effective prescriptions.
The Bangladesh Medical and Dental Council provides a guideline which prohibits certain acts on the part of the physician. These include issuing false certificates, making improper profit, misuse of professional knowledge, abuse of physician-patient relationship, skipping personal responsibility to patient, and canvassing, advertising and using false titles. To stay on the right track, a physician must strictly adhere to the professional code of conduct in any case.
Life is invariably associated with disease; it is the weakest aspect of life, taking us to Greek mythology. "We all have an Achilles' heel -- that part of inner self which was rendered forever vulnerable to mortal cares when we were dipped in the waters of the river Styx as it flowed down the wards of our first disillusionment," says Saha. Medical science manifests the struggle against human ailment. Its ultimate goal is probably thwarting death with the assurance of good health. Immortality is the dream which always lures but eludes medical science. Death is still inevitable and its thought makes us feel uneasy and unhappy. Tagore said once, "Who can prevent death? Each star of the sky is calling him." Saha dedicates a chapter to death, reminding us of the harshest reality in human life. How does a physician deal with a patient on the verge of death? The writer gives some advice on terminal care and breaking bad news. "I am sorry" from the doctor's lips followed by a little silence means something which is well communicated to the patient and his/her attendants. Sorry! As a reader, don't get gloomy. Here are a few words from Shakespeare which should cheer you up (cited by Dr. Saha in his book):
"To die, to sleep;
To sleep, perchance to dream. Ay, there's the rub;
For in that sleep of death what dreams may come,
When we have shuffled off this mortal coil,
Must give us pause."
The book covers a wide range of medical issues, including physicians' communication skills, medical ethics, good medical practice, patient's right to confidentiality, consent to examination and treatment, evaluation of ethical methods, and evidence-based medicine. It is a useful work in terms of its content, although many readers may find the title of the book ambiguous. The writer uses the word 'doctoring' in the special meaning of 'performing duty of a doctor'. But in common parlance, the word 'doctor' has negative meanings as a verb. It may mean 'to change a document in order to deceive people' or 'to secretly put a harmful or poisonous substance into food or drink'. These are harmful acts, which have been associated with the word 'doctor' unfortunately. And see, it is not all good work that doctors always do. Sometimes they are alleged to intentionally make people sick instead of curing their disease, kill them instead of saving their life. As Dr. Saha points out, the killing machine 'guillotine' was invented by a doctor. A fellow of the Royal College of Physicians pushed intravenous potassium to kill a malignant rheumatoid patient to relieve his pain.
The writer makes references to the classical texts of creative literature, the aim being the creation of an emotional effect on readers. He says, "We need to produce physicians who will have a Shakespearean breadth of interest in the wise and the foolish, the proud and the humble, the stoic hero and the whining rogue; we want physicians who will care for people." We come across wise words from Winston Churchill, Maxim Gorki, Anton Chekhov, Dostoyevsky, Somerset Maugham, Arthur Conan Doyle, Sunil Gangopadhayaya and Humayun Azad. We hear the verses of Rabindranath, Nazrul, Jibanananda, Shamsur Rahman and Wrishi Arobinda. We come in contact with the philosophers Socrates, Plato, Kant, Leibniz, Locke, Hobbes and Rousseau. It is like reading a literary work through the hard facts of medical science.
(This review is a reprint in the interest of readers).
Dr Binoy Barman is a writer and head, Department of English, Daffodil International University .
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