It is the Disease that kills and not the Doctor!

Evolution of life on Earth took billions of years. After such a long evolution, nature has achieved huge complexity in the human body that we have today. Every process is meticulously programmed from structural unity, homeostasis and high end defence mechanisms to very complex neural mechanisms we have for a natural life. Evolution gave us not just an excellent body but a developed intellectual capability. Today our Nervous system which not just takes care of almost every response that we have to the external sensory inputs but also capable to store and process such information and create analytical outcomes which has developed our world as we see it today. Our Consciousness has grown immensely from seeking Survival to Innovation.

Understanding of life sciences and major part of evolution of Medicine has happened in last 200 years. In geological time scale, it accounts for a drop in the ocean if we compare to the evolutionary history of developing these processes of 3.8 billion years that the medical science targets.

In the process of evolution of life, these processes that maintains life have come to be known to deviate from their natural course which hampers the natural survival of a particular life. Such deviations, sometimes, are caused by interactions with other forms of life including bacteria, viruses, protozoa and other forms of life including even humans and other times are due to inherent deficiencies or changes leading to various adaptations. Sometime they are natural defects within the constitutional formations of such processes and may also be the effect of environmental factors. Such deviations tend to present as disease and thus cause symptoms which are experienced by any individual human being. A number of such diseases have developed because of many changes in lifestyles and advancements in the technology and occupations in recent times as well.

Medical Science has always tended to understand such changes and defects with the help of observation and experiments to create systems of care which prevent, treat, mitigate and adapt to the effects of such deviations and changes through a variety of interventions. Medical science has been a hope and remedy in the pain of enormous number of humans and shall evolve further to build better care. However, the knowledge and medical interventions are limited by many reasons.

Firstly, such observational knowledge of human body and understanding of natural processes which developed over a very small period of time has to deal with the billions of years of natural evolution of human body and life in it as we see it today. We are still learning new biochemical and physiological processes of the body every day. Medical Science has to answer a lot more many questions about human body and life than has already been answered and many more questions are yet to asked. Hence our solutions to patient’s problems are limited many a times which has been evident during recent Pandemic of Covid as we all have seen.

Secondly, Scientific advancements and technological innovations have helped to understand many natural processes and develop many medicines, procedures, surgeries, investigations and interventions that help in curing the illness and disease. Therapeutics is able to target the primary reason of disease and hence eliminate the offender. This has been possible because of immense research and sacrifices by both academicians, practitioners as well as patients. However, many of such inventions and advancements only support the human body to come back to the sustainable and natural process of life as we have understood and be able to correct itself naturally as the time progresses with those interventions. Therapies target the processes that have been understood and are in no way any magical remedy to the pain and illness. In fact, many new procedures and drugs have not been used many a times on patients that their every possible adverse outcome can be known.

Thirdly, there is a different between other sort of technologies that we see today and the life sciences. The technologies like IT and Software deal with something which have been developed by humans and hence the response is predictable and the processes known. The outcome of any corrective intervention is promising. Such technologies and advancement in sciences tend to create similar expectations from the medical interventions that are done to treat any illness or disease. However, considering the human body is a masterpiece of nature’s invention it is not possible to expect similar promising results in all cases. Medical Science many at times only help to control adverse effects of disease and does not necessarily always treat it. 

Fourthly, every human body has a different natural course of life and has grown in different environment with different pool of genetic combinations and their phenotypic expressions. It is just like every human life experience is different, every human fingerprint is different and every human disease presentation is also different. Because of this the response to therapies and medical treatment are also different for every patient that any doctor helps.

Fifthly, every medical diagnosis and treatment comes at a cost to both patient and doctors. Research has been trying to develop newer methods of treatment which are more complex, more assured but comes at more price. The different types of treatment in today’s world have created choices for patients and doctors based on their affordability and accessibility. It has become very difficult for the practitioners of medicine to match the affordability of the older methods of treatment with the high assurance of outcome of the newest methods of treatment for different patients.

Last but not least, modern world of practice of medicine has created factors effecting the decision as well as outcome of medical management. Culture of patient, relatives and doctors, social practices and stigmas, differences in geographies and language as well as existing regulatory and legal framework have added to the complexity of medical management and limited the outcomes as well as evolution of medical science both positively and negatively in different situations.

It is to be understood that it is the Disease that kills and not the doctor. The variety of clinical presentations and variety of treatments and their possible outcomes create a complex decision making environment which every Doctor has to navigate through and help their patients in the best possible way. Medical Doctors and researchers tend to create probable diagnosis from the presentation of patient’s clinical course and support them through investigations and treat them through their body of knowledge based on learned probabilities and observations. It is to be remembered, thus, that Doctors with their knowledge of medical science over a relatively short evolutionary period, limitations of ever-evolving medical science, highly complex human body and its natural interactions with environment, limitations of therapies and management, extreme and mismatched expectations of both patients and doctors along with financial, social, cultural, geographical, legal and regulatory framework have created a complex ecosystem of patient’s management effecting every aspect of the clinical course as well as treatment and outcomes.

Recent attacks on the medical professionals have unjustifiably burdened full responsibility of outcome of medical disease over them in a very complex ecosystem of medical management. Somewhere we have lost to appreciate that the reason of patient’s undesired outcome has primarily been the disease, and if at all anything else even remotely can be attributed, it’s this complex ecosystem in which a doctor has to help his/her patients. I would certainly caution here and would like to particularly add that there has been cases of medical negligence and criminal misconduct which however needs to be condemned and adequately punished and the professional medical bodies and governments have time and again have taken adequate steps to prevent and punish the guilty, but these miniscule cases, which though exists in every profession, should not blind society towards the complexity in medical management and the existence of these factors of medical management in modern world. Remember no doctor or any medical professional for that matter wishes to lose his/her patient.

Many a times, as we can see today, it happens that doctors do not take bold decisions which previously they used to, due to lack of trust among patients and such fear tend to cause delay in treatment as well as poor outcome later to many such patients. Medical science is no full proof science but is a science of best possible decision making considering the risks and benefits of any medical therapeutic intervention. No therapeutic decision is out of risk and hence doctors always recommend management of disease on the basis of their best judgement and experience for the patients to decide.

However, having said that, patients must see before approaching a doctor whether that doctor has required qualifications and experience in dealing with such illnesses. The decision to approach a doctor solely lies in the hands of patient and in any case if they feel that the particular doctor is not capable to treat him or her well or there is any doubt, patient should take second opinion or should move to other qualified doctor and that is the decision solely in the hands of patients which they must exercise.

Let the Doctor-Patient Relationship remain an empathetic and humble one with flavour of care. Do not spoil it with Anger and violence. Medical Science have saved unaccountable lives and helped alleviate pain of billions of people and shall continue to do so ever.

I hope that the doctor be generous and take bold decisions for their patients on the basis of scientific principles of medicine and patient trust his/her doctor and support him/her in performing his duty.