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Book Review: ‘Dissenting Diagnosis’: A Must-Read For Every Medico

The most amazing aspect about the book ‘Dissenting Diagnosis’ by Dr Arun Gadre and Dr Abhay Shukla is that despite it carrying some extremely depressing and infuriating truths about medical practice in India, it still is the best thing to happen to our profession in the recent past. These 200 pages of honesty and optimism have the potential to do what years of denial, whining, and insincere victim-playing (the typical responses of many Indian doctors and of the Indian Medical Association to criticisms) haven’t been able to achieve: catalyse a huge positive change in the medical community.

Dissenting Diagnosis

This book is not primarily about ‘exposing the rot’ in India’s medical profession, as many in the media are claiming; but yes, it also does not sugar-coat hideous truths about doctors and patients who behave unethically and irrationally. What actually permeates most pages of this book is simply a deep sense of sadness and helplessness regarding the social, ethical and professional mediocrities that pass as medical practice in India today. ‘Dissenting Diagnosis’ is basically about a group of ethical medical practitioners talking about their profession’s declining standards, and then inviting us to join them in their efforts to arrest that decline.

As doctors, we have always known about this ‘rot’, but for a number of reasons (many of them selfish), we as a community not only hardly opposed, but also often actively allowed this disappointing descent. What this book does is bravely saying enough is enough. Till now, it was generally only ‘outsiders’ who talked publicly about the shady truths we have been hiding for decades — something that is one of the greatest failures of our community and of the associations that represent us. But now, through this book, courageous members from our own ranks have made their voices public, especially spurred on by the rapid, scary decrease in the numbers of one of the most endangered minorities in India: ethically practising doctors.

There are two specific myths that this book deftly busts. First, the token defence invariably used by the likes of IMA: ‘Yes there are “black sheep” in our profession, but they are very less; most doctors in India practise ethically and rationally’. Dr George Mathai, a senior physician from Alibag, Maharashtra, contends: I feel that now we will need a microscope to find any white sheep that remain! In other words, while there do exist doctors practising ethically, they are far-far less compared to those who have fallen prey to unethical activities for whatever reasons; and the former are constantly being threatened and frightened into making way for the latter.

The second myth is the sweeping nomenclature of the current state of affairs regarding malpractice and unethical acts as a ‘doctors versus society’ friction. On deeper inspection, this turns out to be highly misleading, and channels young doctors into believing that once into practice, the whole society is going to be against them and that their only ‘saviours’ are their fellow doctors. For decades we have been inhabiting such a closed world restricted to only our own professional colleagues. ‘Dissenting Diagnosis’ makes it amply clear that while ‘society’ has only recently gotten embroiled into these affairs, the primary friction was and will always be between doctors who practise ethically and doctors who do not. As a senior pathologist explained to the book’s authors: ‘Even my MBBS friends — who have now become consultants — do not refer patients to me because I don’t give them cuts.’

This book is significant in that it provides all of us related to healthcare, be it doctors, hospital management personnel, or government officials, a much-needed opportunity for collective introspection. Whatever is currently going on is abominable — on all levels, and by all definitions. While everything is definitely not lost as yet, we risk a swift disintegration of our profession if we don’t heed absolutely urgently to the serious concerns raised in this book. It is high time we stopped playing the victim card and always blaming the society and media for primarily our own deficiencies.

More than half of this book, commendably, deals with what can be done to help ‘clean up this mess’. With chapters such as ‘Joining Hands to Heal the Health Sector’ and ‘Some Solutions Suggested by Doctors’, the authors unravel a few rays of hope and prescribe a list of potential solutions. One of those solutions aligns perfectly well with what is also the most important public health goal for India right now: universal healthcare. To make ethical practice the norm again is indeed an uphill task, and as is clear from this book, while doctors have the most important role to play, significant contributions from the general public, political leaders, and bureaucrats are equally essential.

India’s medical profession thus needs a grand metamorphosis, and the one thing which can make that eminently possible is a rekindling of the humanity we have either forgotten, or been forced to bury. Learning from the lives of those among us who still practise rational and ethical medicine, and taking guidance from them, is one great way to start. This book, too, does exactly that. While the book is highly recommended for every Indian citizen (the language is simple and easily understandable even to non-medico individuals), it is indispensable for all medical students and young doctors, who are the future of Indian medical practice.

Some quotes from the book ‘Dissenting Diagnosis’:

“Doctors angrily question why there is no regulation on builders and property developers. In the first place, we are not builders but doctors! And then, if we ourselves start behaving like builders, people will also treat us as such.”
— Dr Vijay Ajgaonkar, senior diabetologist, Mumbai

“Mothers are ready to breastfeed and doctors tell them not to do so. This is criminal. This way, doctors want to exert their power over patients. The plan behind such advice is to prohibit something the mother can herself do, and take control.”
— Dr Vandana Prasad, paediatrician, Delhi

“I have come to know that the senior office-bearers of many doctors’ associations and organisations in India have been bought up by pharma companies. By not publicly revealing this, they are fooling their own members.”
— Dr Sanjib Mukhopadhyay, gynaecologist, Kolkata

“In order to benefit the (corporate) hospital and meet its commercial needs, one has to do things like keeping patients longer than necessary, and doing unnecessary investigations and procedures. My conscience began pricking me and I left that hospital. Now I only do a consulting practice. I am happy.”
— Dr Gautam Mistri, cardiologist, Kolkata

“We have sunk to such depths that I have come to the conclusion that things will (now) improve simply because there is no way they can become any worse.”
— Unnamed general surgeon

Dissenting Diagnosis
Authors: Dr Arun Gadre, Dr Abhay Shukla
Paperback: 208 pages (Rs 279)
Publisher: Random House (May 2016)

by Dr Kiran Kumbhar

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