Community Medicine: Much More than a Mere Clinical Subject Essay

Abstract: Medical doctors bear a great burden of caring for both the healthy and ill in the society. An avaricious doctor who has thrown basic ethics to the winds is an abomination to the profession. Over the years as knowledge progressed, the art of medicine slowly changed from a â€Å"philosophy† to a â€Å"technology† with emphasis on machines and procedures. There is a danger of a contemporary doctor running amok, treating his patients as diseases and harassing them with the latest technology. The fathers of the medical world after careful thought put together some rules, principles and precepts to help make a modern doctor behave rationally and responsibly. Community Medicine was thus born of a need to help medical professionals strike a balance between man, medicine, society and environment. It is the â€Å"religion† of the medical world! Community Medicine helps us adopt at different times promotive, preventive, curative or rehabilitative roles depending on the need we perceive in the world surrounding us. It may be overwhelming to realize that our understanding of clinical tools(diagnostic or therapeutic; preventive or curative) must be much more than all the specialists put together if we are to do any justice to the common man in his family or community! It may be sobering thought to realize that when medicine finally becomes thoroughly commercial, we will have to play a significant role in moderating our colleagues and the medical industry to ensure that our communities remain healthy. Key words: Community Medicine, philosophy, religion, clinical subject Dr. Samson Sanjeeva Rao Nallapu, Associate Professor, Dept. of Community Medicine, NRI Medical College, Guntur District, AP State, India Man is made in God’s image and is essentially good. However due to the various stressors of every day life, man tends to stray from being good. His socio-economic position, expectations of life, experiences in life and desires etc. make him behave anywhere between â€Å"not so good† to down right evil†; from â€Å"not so satisfied† to â€Å"immoral†, â€Å"covetous† â€Å"greedy† and â€Å" self-indulgent†. To overcome this we have religion. All religions fundamentally advise man to be contented and moral in his relatively short span of life. Every religion propagates a set of laws which help man choose between good and evil. They show men a way to live in harmony with his neighbor and his environment. Religion also promises man eternal life and riches in the hereafter as awards for a life spent being and doing good. By now, if you are still reading, you may wonder where I am heading. Well. This simple analogy can be applied to o ur subject i.e. Community Medicine and the medical world at large. Medical doctors bear a great burden of caring for both the healthy and ill in the society. Doctors have to be exemplary people teaching their patients to lead healthy lives and helping them to overcome illnesses. Doctors therefore have to lead lives of moderation, always willing to help those in need and ready to give necessary advice. The grateful community in turn respects and even deifies their doctors. A greedy, money grabbing doctor who has thrown basic ethics to the winds is an abomination to the profession. The same applies to a doctor who is only interested in the curative aspect of disease due to the pecuniary benefits it fetches him. Over the years as knowledge progressed, the art of medicine slowly changed from a â€Å"philosophy† to a â€Å"technology† with emphasis on machines and procedures. The precepts of medicine which are nothing but what we read today as principles of Community Medicine, are slowly becoming irrelevant and obsolete to today’s pr actitioner. There is a danger of a contemporary doctor running amok, treating his patients as diseases and harassing them with the latest technology which is his ammunition. The fathers of the medical world after careful thought put together some rules, principles and precepts to help make a modern doctor and the learned people in the community behave rationally and responsibly with regard to health and healthcare. So there we have it. Community Medicine was born thus and it is the â€Å"religion† of the medical world! As all religions go, however, some believe and many do not; some accept it and many do not. Many even revile it and belittle it. Religion is all encompassing to the believer but terribly boring to the skeptic. Therefore we find ourselves defending our religion, trying to propagate it, searching for converts and disciples. We are dealing with the truth, but circumstances and the state of affairs hinder people from recognizing the truth. So here we are today, all of us in the profession of medicine, basic doctors first and only then specialists. Community Medicine puts things in perspective. Our field talks of comprehensiveness, inclusiveness and wholesomeness. We can neither divide the body from the mind nor man from his society, his culture and his environment. We as priests of this medical religion are compelled to uncompromisingly put forth our thoughts and ideas to the world at large and especially to our hospital colleagues and others. As teachers of the subject we cannot undermine our role in shaping the young minds entrusted to us. It is a great opportunity to help these young ones to look at medicine again as a philosophy and not purely as a technology. Looking at it from this angle we realize that Community Medicine is much more than a clinical subject. It may be promotive, preventive, curative or rehabilitative roles that we adopt at different times depending on the need we perceive in the world surroundin g us. We have to however keep in mind that all these approaches carry equal weight when evaluating the bigger picture. Yes! We are clinicians! But it is just one facet of our function. We need to be clinicians because that makes us better health educators, better preventive medicine practitioners and better rehabilitators not just for our patients but their families and even their communities. It may be overwhelming to realize that our understanding of clinical tools(diagnostic or therapeutic; preventive or curative) must be much more than all the specialists put together if we are to do any justice to the common man in his family or community! From a practical point of view, as we can think comprehensively and are rooted in reality, understanding the patient in a complete way, we can help the narrowly thinking curative specialist in our hospitals to effectively counsel his patient. (The above specialist came into being because we failed to convert him when he was our student). We can strive towards empowering our colleagues to inculcate promotive and preventive aspects into their practices. If they show reluctance, we can do it ourselves; mainly to help them see that it works and their patients will be more satisfied and self reliant. However our ultimate goal has to be the transfer of responsibility back to their shoulders. If we hold on, we will again be the cause of separating medicine into unwholesome sections. We need to remember that only a small proportion of people suffering with diseases come to the hospitals. The rest are out there undiagnosed, uncared for and untutored. Again if our approach is to â€Å"keep people healthy† and not â€Å"cure people with disease†, the community is where we have to be. To reach out to the masses we need to first go out to where they live and use all our skills – communicational , diagnostic, curative, persuasive etc. to empower them . In this process we may draw on health care facilities at different levels, primary, secondary, tertiary etc. or even the grass root level people like the Village Health Guide, the trained Dai or the ASHA. Just like a surgeon can teach a student, practical and functional anatomy better than an anatomist, we can teach our students better because of not only our clinical assessment and skills but also our comprehensive knowledge of the patient. In the debate whether we are clinicians or not, there is no doubt at all. We are more than clinicians. We are the glue that puts the various aspects of medicine together. We keep hearing that there is a stigma attached to Community Medicine. We hear complaints that other specialties do not respect us. In today’s world, we feel that a person becomes the temple priest because he was not good for anything else. People become priests for various reasons, one being the desire to show others the way to heaven. It depends on the priest to show his knowledge, understanding and ways to gain the respect of the devotees. Similarly we need to find appropriate spaces; be it the hospital or the community to showcase our substance. First and foremost we should stop putting ourselves down. It may be sobering thought to realize that when medicine finally becomes thoroughly commercial, we will have to play a significant role in moderating our colleagues and the medical industry to ensure that our communities remain healthy. Simply put, we hold the key to the future of medicine in our country.