Doctors Demoted?

Dr. Vijaya Raghava

Times have changed a lot from when we were young medical students. At the time, the doctor was at the center of medical practice. The doctor's knowledge was seen as paramount, and his direct diagnosis of the patient was paramount. The doctor would directly observe the patient using their own senses - through sight, touch, ear, and even occasionally smell - in order to hit upon the right diagnosis. Accurate observation and diagnosis were the hallmarks of a good doctor, and were highly treasured. This is why we all enjoy the famous Sherlock Holmes series - they were written by a doctor, Arthur Conan Doyle, who knew how to show the unique skill of observation that was at the heart of medicine. The Doctor is the first Detective.

And with time, things have changed. The doctor's role began to shrink. As one machine after another began to replace the senses, the doctor's healing hand was gradually transformed into a completely "hands off" role. What began with the stethoscope and the BP apparatus mushroomed into MRI's, CT scans, X-Rays of every kind, blood tests, urine tests, innumerable slides under innumerable microscopes, robotic arms... and the diagnostic process was also outsourced to the machine more and more. The lab results began to dictate what is normal and abnormal, the numbers became all-important. The doctor's diagnosis was mostly outsourced to the diagnostic lab. The pharmaceutical companies began to spend heavily to influence the doctors, transforming them into glorified pharma reps. And everyone seems to agree that "When in doubt - Google."

And this is how the doctor sits uneasily in his chair today, almost shrinking into nothingness:

Many of the support structures for the doctor have now become the main role, and even if the doctor is rich monetarily, the fundamental satisfaction of directly engaging and healing a patient is greatly diminished. One becomes more a cog in a gigantic machine than an individual agent who is free to heal.

But you can argue - aren't all these gadgets, diagnostic labs, and drugs, a great step forward in medicine? So what if the doctor is not engaging in the old-fashioned one-on-one way? Won't robots and artificial intelligence (AI) come and sweep away the need for doctors anyway, and we will all be healthy and happy?

Alas - that is not the case, and for a very basic reason. The glamour of offloading a human capacity to a machine is nothing more than a dangerous mirage in the desert - because it assumes that man is a machine. A human being is most definitely not a machine, and by allowing mechanized automatic processes to take the place of the direct human interaction, we pay a heavy price in terms of human health. Does a rock need to be healthy? Does a bottle of acid grow ill? By using mechanics, physics and chemistry instead of a true science of life, we sacrifice health at the very foundational level. And just as you can't grow a coconut tree by planting a pebble, you cannot grow health by depending on a machine.

And that is what doctors need to understand. If the wave of mechanization drowns them, then all of society pays the price. But if they are able to keep their head above water and actually further upgrade their diagnostic and healing skills, only then will they still be doctors, and only then can we still have health. What we need is a new Sherlock Holmes - who observes not only the physical details but also the invisible details. That is our philosophy.