*Evolution of medical practice!**Do we need to introspect?*

*Mind,Moods and Magic Dr Harish Shetty:*
*4 JUN*

*DR YESHWANT AMDEKAR*
[Dr Yeshwant Amdekar a Pediatrician and a legend in the field of Medicine spoke on the ‘evolution of medical practice’ at the INDIAN MEDICAL ASSOCIATION Margao Branch Goa yesterday. The talk that will be soon on the ‘You tube’ was Wisdom Personified. Drawing on his huge experience of a 50 year of Medical practice He was candid and insightful on the need to introspect by the medical profession from a man who’s Practice is a mirror image of his Percepts. He touched the audience in many ways. 
Sharing the Excerpts of the same in a Q/A form just for the benefits of the Reader]
*Q] What is the present scenario of Medical Practice ?*
    A] In the past, patients did not care about how much you knew but they knew about how much you cared and they were satisfied. They had faith in the doctor and held him in high esteem. They understood the limitations of science and the Doctor. Now they expect cure instantaneously. So Doctors overindulge in tests and medicines in the hope of playing safe, increasing the cost of treatment.

Lack of communication and counseling has lead to dissatisfaction. 

Lack of faith in Doctors has lowered the dignity of the medical profession. 
       *Q] What is the ideal Doctor Patient relationship? What are the changes seen today?*

     

       A] This forms the foundation of medical ethics. It needs to be built with mutual faith and trust. What is necessary is the Doctor seeing the patient through his/her eyes. This is based on mutuality and active participation and shared decision making. Today’s parents have outsourced the health of their children to Doctors. I tell them that they have to take care of their children and I can only guide them. Doctor centered approach, where Doctor is the expert and the patient has to abide by the expert is not advisable. The consequences are there to see today. Community acts in vengeance with unacceptable violence. Once at the Wadia Hospital where I am the chief a group of people surrounded a resident doctor and I was called. I went there and asked the relatives if there is any teacher among them. There was one and I asked him whether all his children pass in the exams and they got the message. 
       *Q] Is there need for Introspection?*

    

        A] Yes! We must accept the fact of deteriorating Medical Practice. If we accept then there will be change and we owe it to the next generation. Slowly the perception of our profession will change if we persistently change our methods and our conversation. Breakthrough in medical science has not translated in a breakthrough in human health. It simply means breakthrough in commercialization. Sometime back I saw an X ray of a child showing a fracture but the child could run easily. Clinically I did not find anything wrong. The family insisted that the fracture needs to be treated. I felt here that the X ray needs to be plastered and not the child. Instead of making sensible decisions ourselves there is spurious outsourcing of common sense to modern technology. Opportunity for exploitation exists in Medical Practice. Rapid fire investigations and gunshot therapy are often based on external motivation, incentives or fear of punishment.

  

      *Q] What are the attributes of quality care?*
      A] It has to be based on science based clinical decisions. Analysis of a detailed history is very important. I am shocked at the number of tests young clinicians ask for. At the hospital where I am the chief I ask the Doctors to take a detailed history. In 85% of the cases the diagnosis is clear on history taking alone. I ask them to write down the tests they would want to do and write down the expected results that they anticipate. Let us treat the patient and not the tests. Relevant tests needs to be asked for. Treatment has to be rational, cost effective, timely and equitable. When I became an HON PEDIATRICIAN at a big general hospital, J.J Hospital My teacher told me to uphold the dignity of every poor patient. And he said that these poor patients will send the rich ones to my clinic. I did not understand this then but I realized later what he said. In life give more than what u get and you always get more. It is not necessary that a well dressed person is only a gentleman but a beggar who comes to my hospital is also a gentleman. 
     *Q] What are the challenges the profession is facing ?*
     A] Medical Science is a dynamic process leading to a changing disease process. For e.g the malaria parasite does not give us rigors always. The parasite knows that Science has discovered the symptoms and so has changed its profile to confuse science. The ‘organisms ‘are transparent and share all the information to their brethren so that they become a formidable force against medical science. Human beings in contrast may not share all knowledge with the fear that the other person may become smarter than them. Symptoms that have been taught to me 50 years ago are no longer the same. We need to learn, unlearn and relearn and keep ourselves updated. High dependency on tests has widened the gap between traditional wisdom and modern science. We have started treating the reports rather than the patient. I wonder whether Super specialization is a boon or a bane. Super Specialists need to be generalists first. My friend an Endocrinologist abroad makes his trainee doctors to work in the general pediatric O.P.D before graduating from the specialization. In a lighter vein if you show a cow to an intern he will say it’s a cow. If you show it to an MD he will say, it may be a cow but one needs to verify with evidence. If you show the same animal to a super specialist he will say that there are many possibilities, it may be a atrophied elephant or a hypertrophied goat. Not forgetting simple sciences are important. 
     *Q] Sir, what about the Art of Medical Practice ?*
     A] Art of practice provided quality care even when Science was not fully developed. Modern Science and Technology has replaced the art of practice. Good General Practitioners are rare. Art of science is missing and science is also practiced without updating. There is a lack of role models for the next generation.
    *Q] What is holistic care Sir?*
    A] It is about selfless care and complete devotion. Knowledge, Commitment, Compassion & inner conscience needs to merge. We need to work with our brain and listen to our heart. Being honest, transparent and accountable is the key. Holistic care can lead to divine healing. 
    *Q] Can we reverse the present trend of bringing back the faith of the community back to our profession?*
    A] Yes off course! Think about this phrase, ‘Do unto your patient as you expect other physician to do unto you, if you were a patient! ‘Dwell on this and let the meaning be wired into your unconscious mind. Deliberate practice will convert conscious incompetence into unconscious competence. This needs hard work and passion. Think about your weakest and poorest patient and contemplate the steps you would take to help them. Apply these tests and Pride will be replaced by Humility and dismay. Be optimistic and put your best effort. It will bring you joy and happiness !
   *Q] Talking about happiness, How can doctors be happy?*
   A] Life of a Doctor is complex and like a tennis game! You serve and you get a return and whatever it is it begins with love all. It is like riding a bicycle. You need to ride and if you stop you fall. It is like playing a piano, one need to play both the black and the white notes to get good music. The best definition of Happiness that has touched me is one that Robin Sharma shared. He says ‘It is the unintended side effect of the good you do to others’. Happiness is in what you need and not what you greed. Success lies in happiness! If you are happy you are happy practicing medicine. If you are convinced you can convince others. I have a group practice in my clinic and am stress free. Be internally motivated with hard work, passion and joy. It relieves stress and brings in happiness. Do not forget life has an expiry date so look after your own health, so that you can die young as late as possible. 
*_Copied from the Blog by Dr Harish Shetty posted on 04/06/2017_*

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