Remember the good old days of the 1960s? Of course, most of the souls who are reading this — including me, didn’t even exist back then. But we have seen it in movies, right?he son, ‘chirag’ of the family is grievously ill and lies groaning on a small cot. The mother is sobbing, wiping her tears with the saree’s pallu. The father sells family jewelry to arrange money for a doctor. The doctor arrives in a white-colored Ambassador, the iconic car produced by Hindustan Motors. The father greets him with folded hands, “Doctorsaab, bacha lijiye mere bete ko”. He is aware that his son is probably on the deathbed. The doctor walks into the room without replying. After a while, he comes out and says “Haalat bohot burri hai. Ab sirf bhagwan se prarthana kar sakte hai”. Everyone starts crying and the doctor leaves after folding hands into a namaste. The son dies thereafter.
Now, cut the drama and analyze the doctor-patient relationship back then. A doctor would generally charge huge sums of money and wouldn’t be called until the world is ending. Most people didn’t have cars to transport the sick, so a doctor would ideally go to the patient. Though most patients had a dismal prognosis, no one harms the doctor — even as the doctor enters into the ‘dangerous’ community outside the ‘protected’ walls of a hospital. However, we shouldn’t err to conclude that everyone respected the opinion of a doctor or that people were less stupid back then. I read about an interesting doctor-patient encounter in my Hindi textbook in middle school. I don’t remember the name of the writer, but I am sure he was someone influential.
He describes an ill woman who is being treated by an Ayurvedic Vaid. This Vaid has told the woman to bury herself under as many blankets as possible, shut off all the ventilation in the room, and eat bland food only. The elderly women of the community greatly respect Vaid’s opinions. The woman becomes thin and frail as her illness continues for few months. Now that I look back, it was probably Tuberculosis. Later, she manages to convince her husband to sell the jewelry and call a doctor. The doctor arrives in a traditional Hindi movie style. and advises the patient to open windows for increased ventilation, remove the blankets and consume a rich diet. He jots down few medications and goes away. An elderly woman tells the patient, “Yeh mu-ae doctor ko kya pata. Vaid ki baat suno. Pasina nahi niklega to tabyat theek nahi hoga. Itna paisa lete hai par kuch aata nahi” (The idiot doctor knows nothing, listen to Vaid. Without sweating, you won’t improve. He takes so much money but knows nothing). Other women nod in agreement. However, the patient continues heeding to the doctor’s advice and gets better.
Though morons like Ramdev definitely aggravate hostility against doctors, skepticism and a general mistrust for modern medicine is deeply rooted in the Indian society. My mother recounts that she developed an illness when she was a young but her grandmother didn’t allow her to be seen by a doctor. After much ado and delay, she was finally taken to a hospital and narrowly escaped grievous consequences.
Mistrust has been prevailing for long. Why are people inflicting violence on doctors now?
Let’s review a bit of psychology. In the old days, whenever someone fell really ill, people would tend to undergo 5 stages of grieving as explained by the Kubler-Ross model.
Denial- They refuse to accept that the person is ill enough. “It’s fine. It’s just a fever. He’ll get fine soon. Yes he’ll get fine”
Anger- They blame it on someone or something. “Pakka padosi Lila ki nazar lag gyi. Bohot gandi hai woh”
Bargaining- They would try to mitigate the situation. They will consult vaids, elderly people of the village and finally, they would call a doctor. They would give any amount of money to save their loved ones (Bargain other pleasures of life for the patient’s health). They would typically also bargain with the God- “I’ll keep a fast every month, please save my son.”
Depression- The doctor pronounces that the patient is not irrecoverable. Everyone cries. Everyone is sad.
Acceptance- That’s making peace with the loss.
Though it is not necessary for the five stages to occur in a sequence, it generally occurs this way. Back then, the family members would be bargaining or moving to depression after consulting a doctor.
It’s much different now — doctors are relatively easy to find in primary health care centers of every village and they treat for free since the government pays for them. Even in private establishments, the standalone fees of a doctor is in the range of 300–1000 rupees. A poor patient who earns Rs.10,000 a month need not sell jewelry or turn to long-term savings to afford this.
Earlier, only people who believed in modern medicine would take the effort to call a doctor, unlike now- where everyone, whether they believe in allopathy or not, calls a doctor. Earlier, vaids would be the primary caregiver. Doctors were called only when vaids were helpless. Now, doctors are the primary caregivers. Vaids are called when doctors are helpless. The primary caregivers are most likely to face the wrath of patients — just because they are responsible for the patients while the secondary caregivers are just meant for advice.
Moreover, doctors used to be really rich compared to the general population in the previous century. They would be amongst the privileged few who own a car and telephone. As a general human tendency, people respect the very rich. For good or bad, the gap has reduced now. Rich landlords in villages earn much more than an average doctor. From a high-class cultured figure, the doctor has assumed a more subservient figure in Indian society.
Further, death used to be an imminent possibility when someone fell ill. People used to worry in anticipation of the death of a patient. Nowadays, with advancements in medical sciences, people don’t usually anticipate a grievous outcome when someone falls ill. Calling a doctor is no longer a last-ditch effort, rather it is assumed that a doctor can eventually cure them. And if a doctor is not able to do so, it’s because of the shortcomings of the doctor and not medical science itself.
So, the attendants are usually in ‘Denial’ even if the patient is terminally ill. They think medical science will cure them. They would take the patient to a doctor while still being in denial- “the doctor will cure him”. However, when the patient dies, they instantly jump to the stage of ‘Anger’. They have an easy blame — the doctor and not the “padosi aunty’s nazar”. And now, the doctor faces their wrath. They believe it’s the incompetence of the doctor that killed the patient and not the shortcomings of medical science itself.
Wrath alone is not enough. The incessant support and sympathy from local politicians and policemen make violence an option. Instead of supporting the doctors, politicians tend to say what the public wants to hear- that the death of their loved one was not an eventuality, but an arduous murder committed by the doctor. Convinced by this support, the public resorts to an immature psychological defense — ‘Acting out’. They feel that the doctor has wronged them and it's their right to take sweet revenge. WhatsApp forwards chiding modern medicine add fuel to the fire. Since doctors are no longer rich and powerful, people find it easier to harm a helpless doctor.
Violence seldom occurs when patients suffering from chronic diseases like cancer die. The attendants have usually passed the five stages of grief by anticipating the death of the patient. Even in acute diseases, if the patient is brought early, doctors can let the family know about the prognosis. The family gets some time to absorb it. However, when an acutely ill patient is brought at the end-stage, an eruptive atmosphere is created.
We need to restructure Indian society. Until politicians stop providing immunity to the violence-makers, doctors will remain under fear. Until and unless doctors are given the power of a VIP, doctors will remain under fear. Until the patients understand the limitations of modern medicine and the futility of Ayurveda, doctors will remain under fear.
- Several employees of a pharmaceutical company have been arrested in Indonesia for allegedly washing and reselling used Covid nasal swab test kits.