Young doctors must introspect, too

AS I write this piece from Kolkata, I see young doctors coming to the street, raising their voice, exposing the huge network of corruption, or the tyranny of 'threat culture' that operates in government hospitals in West Bengal, and demanding safety and protection in their workplaces.

Will it be possible for young doctors to feel somewhat uneasy with the way their profession has been transformed into a trade or a profit-making business?

Yes, their determinism, or their courage to fight the ruling political establishment, is indeed praiseworthy. Yet, I feel like appealing to them and their senior colleagues to widen their horizons, become sufficiently self-reflexive, and also critically examine the discontents of the hegemonic biomedicine — its power discourse, its commodification, and innumerable malpractices associated with it.

Well, I too adore doctors; and I am aware of the remarkable achievements of modern medicine. Take insulin, control your diabetes, and lead life reasonably smoothly; or, go for a knee replacement surgery, and walk once again confidently — yes, the heroic tales of modern medicine can be heard in every household. But then, these achievements notwithstanding, I cannot deny my ambivalence, and even some serious critique of the modern biomedical establishment. And I want young doctors-particularly, because they have not yet lost their critical thinking, to reflect on this critique, and give a new meaning to their struggle.

Well, young doctors need to reflect on the prevalent politics of knowledge. Isn't it a fact that it is fairly easy to debunk 'traditional' medical systems like ayurveda, unani or homeopathy? If, as a patient, you dare to speak of the discontents of the modern biomedical system, you are likely to be reminded that you are merely a layperson; and hence, it would be better to accept everything your doctor suggests or prescribes.

In fact, the power discourse implicit in the hegemonic biomedicine, as Ivan Illich articulated with great insight in his classic ‘Limits to Medicine’, "disempowers the patient."

But then, as a patient, you are not just a discrete body with a set of measurable parameters (say, your blood culture, or the findings of your biopsy report); you are also a living soul with consciousness and agency; and you might have your own choice regarding the way you wish to live or die.

Should you pass through a painful process of chemotherapy in the ICU of a super-specialty hospital, and live with a faint hope that you might get temporary relief from the pain of 'acute myeloid leukemia', and survive for another two months?

Or, should you refuse to reduce yourself into an object of experimentation and choose to go back to your home, and eventually leave the world amid the presence of the loved ones in your own bedroom?

Nobody — not even the best doctors with the power and aura of 'scientism', and the technology of artificial life-support systems -- should be allowed to deprive you of your choice or your agency.

However, the irony is that because of the hegemonic biomedicine, and, to use Illich's words, the resultant "medicalization of death", most of us seem to have lost our control over the experience of living and dying.

Not to say 'yes' to everything the doctors and associated pharmaceutical industry suggest is often ridiculed as an act of irresponsibility, or a demonstration of one's 'anti-science' temperament!

Likewise, will it be possible for young doctors to feel somewhat uneasy with the way their profession has been transformed into a trade or a profit-making business? Of course, doctors need to earn and live a decent life.

But then, we are witnessing how, because of the absence of good facilities in our overcrowded government hospitals (don't forget that public health spending for financial year 2024 is merely 2.2 per cent of the GDP), corporate super-specialty hospitals do not hesitate in selling 'good health' as a commodity with an 'appropriate' price list — say, ICU: Rs. 90,000 per day; or deluxe room: Rs 75,000 per day; or attractive 'packages' or 'discounts' for bypass surgery and kidney transplant.

No wonder, health insurance companies seek to "bring smiles to happy consumers", and advise you "not to worry about cost limit, and focus only on your recovery"!

However, if you acquire the courage to keep your eyes open, you can easily see the speedy transformation of a noble profession into an ugly trade involving the chain of corporate hospitals and nursing homes, all-pervading health insurance companies, and, above all, the $65-billion pharmaceutical industry.

Is it the reason why middle class parents are willing to sell their property, and send their children to dubious private medical colleges so that they can become 'doctors'?

And, finally, should the practitioners of modern biomedicine recognise the social/economic dimension of disease and illness? For instance, can a doctor cure your chronic bronchitis only through costly medicine, if you are constantly exposed to polluted air because of your social location as a construction worker or a labourer in a coalmine? Or, for that matter, can even the best doctor help you to free yourself from the recurrence of stomach ailments and jaundice, if the state fails to provide clean and safe drinking water to the slum you live in and you don't have the money to buy heavily priced filtered water bottles?

Possibly, 'value-neutral' medical science does not want to ask difficult social/political questions; instead, it is easier to see the patient as just a 'discrete' body and ask him to go to clinical labs for a battery of 'tests' he can seldom afford!

Yes, as Kolkata has demonstrated, young doctors are bold enough to protest for their rights and dignity. But then, will it be altogether wrong if you and I expect some amount of self-introspection from them so that they can also raise their voice against the pathology that has dehumanised the modern biomedical system?