NEED TO BALANCE THE ART AND SCIENCE OF MEDICINE

Former AIIMS director Randeep Guleria explains the shift from clinical to investigative medicines and the rising cost during the 20th edition of Delhi Dialogues

- Dr Randeep Guleria, Chairman, Internal Medicine, Respiratory & Sleep Medicine, Medanta

Shahid Faridi: How has medicine changed over the years?

What was clinical medicine when I was training has now moved to what is known as investigative medicine. We were taught that you examine a patient in detail and do the least amount of investigation, reach a diagnosis and start the treatment. The focus now is to spend less time examining the patient and write more investigations. It has added to the cost of medicine. How can we balance the art and science of medicine so that we are able to provide good patient care, which is affordable, of high quality, and train doctors in that respect?

We are losing the art of medicine where you examine and talk to the patient. I think that's important, because sometimes you can get a lot out of the patient just by listening to him. We have moved away from that and would order a battery of tests. Sometimes you are not sure whether a report is correct or not, but you go ahead. The focus is more on getting investigations done, which I think is not good in our country, because as you go to rural India, all these tests will not be available. The other thing that has driven this is defensive medicine. This is also adding to the cost of healthcare.

The health sector has improved because there is a huge push by the government to open more and more hospitals and colleges. But I think we also need to focus a lot on quality along with quantity. We are seeing that government medical colleges have become less and the private ones are more. The NMC is trying to cap fees. But the cost of medical education has gone up tremendously. And that is impacting the thought process of students and the way they practice subsequently. So if we want to feel strongly that medicine should be a service rather than a business, then you have to train people from that point of view and with that mindset.

Shahid Faridi: Do you think this is because of mushrooming of private hospitals?