Our intellectuals have failed us - System of a Down.

Medical profession is at cross-roads. On one hand are issues like medical mal-practice and negligence but on the other are loss of respect, low re-imbursement, lawsuits against medical professionals, violence against physicians all contributing to a lot of stress as also a high suicide rate among medical practitioners. While some of the problems seem related to changing societal norms, most of them seem to stem from a failure, active or passive on the part of medical intellectual, moving away from altruism, justice and self regulation to pursuance of self interest with a consequent loss of trust in doctor-patient relationship. The solution lies not only in regaining this trust by following a path of community welfare, change in medical curriculum but also recognition by society, the problems faced by medical fraternity; long hours, low re-imbursement for mental and physical effort but most importantly loss of prestige. Urgent steps to reverse this malady should be undertaken, otherwise a full-fledged commercial and profit making medical field is the only alternative.

Archaeology of problem

Intellectuals are a group of people who have the capacity and responsibility to stand for truth and thus are uniquely enabled to foresee the problems, analyze the short-coming and find a solution (to these problems) within a community. On the other hand a corporeal individual is a person more focused on his material/mental body, emotions, living entirely on impulses (an action-reaction archetype). Historically, communities depend on intellectuals to verify causality of things and to point towards right direction to take. The same holds true for medical intellectuals who should not only be adept in clinical problem solving but also be able to take the entire medical fraternity on a righteous path. This path is of truth, justice and community welfare. However, sometimes these so-called intellectuals deviate from the path of idealism to self good; abandon the path of reason, even indulge in abject dishonesty, using distraction as a tool to regale in twisting of discourse, even. Consequently instead of medical welfare will crop in fallacies of commission; medical corruption and other malpractices like fee-splitting, overuse of investigations and over-treatment on one hand and omission like medical negligence on the other. Corporate interests will dominate over patient interests and individuals will aspire to be on the right side of power systems to enjoy its perks and benefits. On long run, once critical thinking is culturally and chronically abandoned it will lead to rise of counter forces; Visceral emotions instead of reason will start dominating, culminating in hate culture and mob violence, translated into “violence against doctors” and also lawsuits against health-care facilities and individuals. With this onslaught the medical professionals will become prone to commit medical errors and will start practicing defensive medicine. This will also lead to other participants of community trying to bring some discipline and order in medical populace. All these factors would contribute to a high degree of stress to medical professionals, and this combined with long-working hours, less time spent with family and friends would lead to burnout and increased suicidal tendencies. As a matter of fact this is already reality with highest suicide rates reported in doctors among all professionals.

Definition of an intellectual

An intellectual is a person who engages in critical thinking, research, and reflection about the reality, and proposes solutions for the normative problems of society. Thus there are 3 aspects to an intellectual; ability to use critical faculty of thinking, search for truth and use of wisdom to find solutions.

Analysis of the problem

Knowledge can be acquired in two ways; corporeal, an impression which an external or internal object (imagination) makes on our senses or internal milieu, an immediate perception of this thought or sensation. Outcome from this kind of visceral perception is a gut response, which is intuitive but cannot be explained by mere reason. This is the knowledge gained by integration (of information with past memories). Second type of knowledge is intellectual which is acquired by analyzing, pondering on the material that is presented to sense organs or imagination, an act of knowing by comparison and differentiation. It is this kind of knowledge which can lead to unravelling of truth, culminating in development of wisdom. From a societal perspective the second kind of knowledge is more useful because it involves analysis of actions and events according to their causes and motives, going to the core of every problem and contributing to their redemption. Individuals proficient in this kind of knowledge (intellectuals) generally undertake tasks outside their own specialized field, engaging with passion, exposing themselves to risk, but having commitment to principles. They willing to be involved in worldly causes while accepting any underlying vulnerability. Thus they encompass a broad spectrum of ideas; societal good, truth and justice and within communities wield tremendous power that comes from freedom of expression, access to information and political liberty. However, this power also entails a huge responsibility, a responsibility to be loyal to only truth; a revelation of those facts which makes them certain, clear and strong in knowledge and action. True intellectuals would not lie under any circumstance. However, when discarding the common good, pseudo-intellectuals cater to serve interests of self or corporate, and towards this end indulge in distortions or out-right deceit, it brings out the negative aspects of discourse and brings to fore a lot of societal problems we face today, particularly corruption and nepotism. On the other hand there are some other types of pseudo-intellectuals as well, the bourgeoisie – individuals “who treat their work merely as a profession, as something you do for a living, between the hours of nine and five with one eye on the clock, and another cocked at what is considered to be proper, professional behaviour—not rocking the boat, not straying outside the accepted paradigms or limits making yourself marketable and above all presentable, hence uncontroversial, un-political and ‘objective’.” From the point of view of medicine it ends up as medical mal-practices such as fee splitting, overuse of investigations and over-treatments. Once the intellectual (discursive) component human behavior falls into disrepute there emerges the other aspect of behavior, the corporeal or visceral. Positive aspects of this human personality are charity, love, beauty and trust. This is the basis of parent-child relationship, the trust a patient has on his/her physician (and vice versa). However, when this trust is betrayed it culminates in the negative aspects of visceral self;

An exaggeration of emotional response –mob violence and violence against doctors on one end and medical error on the other.

Ignorance and abandonment of reason – hate campaigns, false imprisonment and intentional infliction of emotional stress on one end and medical negligence on the other.

Figure 1

Figure 1

Beneficence and evils in health-care practice. Emperor's New Clothes.

Thus failure of intellectuals is the precursor, a common initial step, often manifested by innocuous phenomenon of lack of committed, courageous and effective public intellectuals but which contributes to moral devastation of any group. Power and privilege demands utter compliance and acquiescence, thus the comfort of passivity (as opposed to pro-activeness), the over-indulgence in the ivory tower, despite nagging conscience? Failure or deficiencies in the intellectual persona is the predominant reason why the trust is lost and human being descends into negative corporeal/visceral self. Here, the human consciousness is characterized by fear, chaos, helplessness, hate and violence, all that is loathsome to a civilized being.

The solution

A less than enlightened intellectual may respond to this situation with naïveté and self-righteousness and indulge in hypocritical moralism but the real solution to this problem lies in regaining trust; trust of patients, relatives, entire community. What is needed is individuals who can commit daring acts of moral courage, “passionate engagement, risk, exposure, commitment to principles, vulnerability and being involved in worldly causes.” Notwithstanding academic credentials, they should take active part in social transformation and restore cultural and traditional values which the comfortable intellectuals have utterly abandoned. Thus self-regulation is the best type of regulation; otherwise there looms a spectre of regulation by others, price capping, legal suits etc.

Another solution to the problem is vocal exposition by medical community at large or at least by leaders of this community that health-care is not a profession of profit and upholds higher moral values and therefore no individual should join it for mere profiteering.

The medical curriculum should be completely revamped to not only include more empathy building exercises like being exposed to “pain of others” but also include literature, art and philosophy in medical curriculum so that medical student becomes proficient not only in health-care but also becomes active in areas beyond medicine like a true intellectual.

The society in general should also realize that at the moment physicians are under a tremendous stress, not only because of rapidly expanding medical field but also changing work-environment (huge physical and mental effort, but deficient re-imbursement) even societal norms (material dominates over spirit, money becomes God), and are rapidly losing their exalted space in the society. The society needs to understand that if it values a non-commercial approach to medicine it should help preserve this genre lest it becomes extinct.

Conclusion

Medical fraternity is currently on cross-roads primarily due to passivity of large swathe of medical professionals and their inability to speak/take action against the evils that have crept up within our profession.

Wake up

I don’t think you trust

In, my, self righteous suicide

I, cry, when angels deserve to die, DIE

Father, father, father, father

Why have you forsaken me