An Uneasy ‘Dis-consonance’: The Medical Profession and Social Reality

I recently had a run in with an old friend and a batchmate at medical college. The point of dispute was the mindless manner the lockdown was imposed on the entire country and the consequences which flowed from it. This is what my friend wrote to me:

“I am in support of policy decisions taken. Although they could have given 48 hours to reach wherever any body wanted to go. You can choose between killing 1 lakh or 10 lakh or maybe more. No decision or policy could save everyone. I am not questioning your rationality but you should also not think that what others are doing is always wrong. Also when you condemn, tell what should have been done.”

The message left me shocked, especially as I know him to be a very nice person and an excellent surgeon. I know many more from the medical profession, my own batchmates, colleagues and teachers, who hold downright reactionary social and political views. Though faltering of late, my friend had never really uttered something so awful as he had this time.

Breaking a relationship is easy, but salvaging one from the brink is a challenge. I decided to take the challenge and wrote back:

“I’d rather frame it differently – the question at no point of time has to be of choosing between killing 1 lakh or killing 10 lakh, especially when the decision of who would get ‘killed’ and who would ‘not get killed’ is taken by those who are assured of the safety of their own lives.

I do not think that it requires extraordinary wisdom to see which class of people are dying as a result of the blind policy decisions of the government. I would rather persevere to protect every human life irrespective of caste, creed, colour, region and yes, religion. It is another thing that, despite best efforts, some lives shall still be lost. We should be willing to call a wrong a wrong, and not counterpoise it with another wrong. I just hope my words convey the sincerity with which I am writing them. Regards.”

Such views have always been propagated and have existed in society for long, but never has articulating them been a matter of faith as brazenly as it is today. Nevertheless, this incident reminded me of another occasion when I had heard something similar.

In 2011, after completing MPH (masters in public health) from Jawaharlal Nehru University, I was looking for a job. I visited a senior physician, who had since taken voluntary retirement from professorship at a prominent medical institute in the country, and had come to head an organisation of his own.

The professor had an idea of my activist background, and it was clear early on in the interaction that I was not going to hired by him. But, for the sake of nicety, the conversation continued.

The professor rued that AIIMS had been reduced to the status of a general hospital; that it was meant to be a research institute but there was too much of a crowd in the OPDs which is why his researchers had no space where they could interview patients.

“AIIMS must cut down the number of patients to the required minimum,” he said.

“But that would be a double whammy,” was my repartee. “First, the health facilities nearer home are dysfunctional or non-existent, which sends them seeking the benign benevolence of public hospitals in cities like Delhi. If denied treatment even here, many of those in the long lines would end up dying. Why can’t the AIIMS faculty use its privileged position to demand from the government that it should strengthen the public health system in the periphery; after all, isn’t research meant for the people?” I suggested, imploringly.

“No, the job of the AIIMS faculty is to do research. If some have to die, then so be it, but we should not lower the standards,” he protested.

“Then, it is also clear that it is the latter half of the line (the lower strata) who will die,” I stood my ground.

The purpose of my narrating these incidents is not to make the profession I once belonged to a subject of your retribution. The above incidents merely show what the dis-consonance between the medical profession and the larger social realities can result in. I shall come to the purpose of this article in a while, but, before that, let me gladden your hearts a bit.

Also read: The Stethoscope Versus the Fist: A First-Hand Account

In 2006, a close friend, and a senior professor at AIIMS at a super-specialty department, had a providential lecture with undergraduate medical students. Having talked about his subject, towards the end, he implored his students to think of the societal conditions in which they would be practicing medicine, and whether these conditions would enable a vast majority of people to be able to avail the expertise they were to acquire. He then asked the students if they would wish to do something about a massive hike in ‘user charges’ for patients – that were already in the offing at AIIMS at that time.

The ‘poser’ by my friend caught the imagination of some students. They invited us for a larger meeting at the hostel where the issue was discussed threadbare. Once convinced, they resolved to observe a black day against the hike in user charges. The ‘Black Day’ was so stupendously successful that these storm troopers took the AIIMS administration aback. The proposed hike in user charges was withdrawn. Alas, this alliance could not weather the onslaught of the ‘upper caste chauvinism’ that erupted throughout the country with AIIMS as its epicentre, later in 2006.

While sharing the professor’s keen desire for developing centres of excellence in medical research in India, this author would insist that doctors ought not to conceive ‘excellence’ that is detached from the requirements enforced by the conditions in which life itself is lived. What these medical students achieved through their solidarity for the people – should that not be a part of the excellence that we aspire for, especially as such acts flow from the core ethics of medical profession?

Also read: 27-Year-Old French Doctor Thrown Into Coronavirus Front Line

Unfortunately, what ought to be ‘impossible’ have become increasingly ‘possible’; and what ought to be possible, or rather necessary, is seen as increasingly inconceivable. In the ‘shareholder primacy model’ of healthcare the reigning deity is ‘profit maximised’, and not the ‘patient’ – let alone the ‘human being.’

In order that this becomes seamlessly translated in to action, an acute need is felt for cultivating increasing ‘dis-consonance’ between the health professionals and the society at large. If the rulers have their way, then the only link between the two would be the ability of the patients or their families to purchase the services of healthcare professionals at terms dictated by the owners of ‘capital’. Of course, such ‘dis-consonance’ is cultivated insidiously, through sophisticated, though dubious mechanisms; in the name of the people.

The state then uses this ‘dis-consonance’ to drive an even wider wedge between health professionals and the people at large. The recent ordinance by the Central government enhancing the punishment for any attack against frontline health workers, unmindful of the context in which the government’s own actions rendered these workers vulnerable, is the latest example of this.

It is time that the healthcare professionals realise that their protection lies in their empathy for peoples’ suffering, which alone shall make the people hold them in high esteem and ensure their protection.  The need is to bridge this uneasy ‘dis-consonance.’

Dr Vikas Bajpai is a National Executive Member of the Progressive Medicos and Scientists Forum (PMSF).

Featured image credit: Hush Naidoo/Unsplash