As I came to appreciate after countless hours in darkened lecture halls, the biomedical view of disease looks piercingly through a patient toward some essential, objective, solid reality of biology—and yet in doing so it loses, like an X ray, almost any sense of flesh of the person.
– Chris Feudtner, ‘Bittersweet: Diabetes, Insulin, and the Transformation of Illness’
If you are a medical student in India today, you probably are anxious about the medical practice scenario in the country, including the high levels of mutual mistrust between the medical profession and the society (which at times has frighteningly culminated in physical violence). The reasons behind this souring of the society-doctor dynamics in India are pretty complex, a topic I am studying in detail for my PhD thesis. But one of the factors on which there exists a general consensus is what is sometimes called the ‘communication gap’ between doctors and patients. As doctors, almost everything we learn about health and ill health is from the point of view of only doctors and researchers, and not of patients. That is why when we communicate with our patients in the clinical setting, we often end up offering them a good ‘treatment’, but not exactly making them feel ‘cared for’. Besides, on many occasions patients – especially women patients – end up feeling offended, hurt, or despised (though the average patient rarely shows these feelings to the doctors and other medical personnel).
You might have heard some oft-quoted medical maxims that go like ‘Treat the patient, not the images/lab values.’ This is one of the most profound and fundamental aspects of medical practice, but one which you will struggle to remember and implement because you will witness the exact opposite at most stages of your education and training. However, there are ways to productively complement the ‘treat the images/lab values’ training, one of them being reading and understanding health and ill health from perspectives other than those of medical doctors and researchers. The more you understand and assimilate these perspectives, the more you will incorporate the ‘treat the patient’ philosophy in your thinking and analysis.
In addition to the patient perspective, you also need to incorporate the social/political perspective in your thinking, which too is not a part of conventional medical training. As doctors, we have to understand not only the biochemical and molecular mechanisms of ill health, but also the societal, cultural and political factors which give rise to conditions that cause ill health.
The list that follows is a list mainly of articles which I strongly feel medical students – and all doctors in general – need to read along with their conventional medical textbooks (I will continue to expand this list over time.) After my MBBS at B.J. Medical College Pune, I worked as a medical officer in different hospitals and parts of India for four years, then studied public health at Harvard University in Boston. Right now I am in a PhD program there, studying the history and philosophy of medicine, and medical anthropology. The stuff below comes from my reading lists for various courses in these subjects at Harvard and my own research on medicine and health in India.
[For those interested in the history of medicine, here is another reading list I have compiled.]
The medical gaze, or the short history of how doctors began to be trained to treat images/lab values instead of treating patients.
Everybody Loves a Good Drought. This enlightening book by journalist P. Sainath is one of the best introductions to the lives of rural Indian people. The sub-section titled ‘Health in Rural India’ is highly recommended.
Disrespectful treatment of women. The earlier you know and learn about this, the better it is for the future of medicine in India. Every student needs to understand (and avoid) the subtle as well as explicit ways in which obstetric treatment can transform into disrespectful treatment of women and their relatives, often worsening into ‘obstetric violence’. Besides, this and this describe some of the insensitive ideas and habits regarding examination of women patients that we pick up during conventional medical education.
You must have heard about the complicated relationship of doctors with the pharma industry. While you will read and hear a lot about it throughout your career, this book excerpt is a good way to begin.
Structural violence is a crucial concept for every doctor to know. In fact it is so common a phenomenon that you might have come across some discussion or manifestation of it already (‘structural violence’ is just one name for something that can be described in many different ways).
You will often hear comments like ‘overpopulation is the cause of most of India’s problems’. As persons in the healthcare field, this issue colors our perspectives in many ways. However, it is important to understand early on in your medical life that the so-called population problem has been vastly misinterpreted and exaggerated.
Medical anthropology is a fascinating discipline though we get to know absolutely nothing about it in conventional medical education. One of the things that medical anthropologists best do is delving deep into how patients and the society imagine healthcare and what they think about doctors and health policies. Here and here are two good examples of this kind of research.
[THIS LIST WILL CONTINUE TO BE EXPANDED. YOU CAN ALSO EMAIL ME if you want suggestions for reading or wish to discuss any other related topic (firstname.lastname@example.org).]
Image courtesy Wellcome Collection