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Wednesday, August 27, 2014

“Highly Admired” Captain Dr. Venkatrayudu of Tenali of the 50s

As I browsed through a few pages of the book, Doctored: The Disillusionment of an American Physician, by Dr Sandeep Jauhar, the India-born American cardiologist who is now in his 40s, particularly his observations about the “the halcyon days of the mid-twentieth century” physicians who, according to him, used to “set their own hours and … fees” and were the “highly admired professionals”, my mind at once raced back to the 1950s when I had,  for the first time, visited the clinic of Captain Venkatarayudu, MD, the much talked about maverick doctor of our small town, Tenali.    

Captain Rayudu was known for his impeccable medical knowledge, particularly clinical excellence and prescribing bare minimum medicines, besides being forthright in letting the patient know about his medical status, however unpleasant it might be. Captain Rayudu, being a doctor educated in UK and trained for quite sometime in UK hospitals, used to be distinctly different in his approach to dispensing medical service to the patients. There were innumerable stories in circulation in the town about his strict code of conduct even to the relatives of an about-to-die patient. 

Being endowed with a gigantic physique that was invariably adorned with a long white coat, a stethoscope hanging around his neck and a military hat belted to his neck, as Dr Rayudu grasped the forearm of a patient for reading pulse, it invariably raced, for while he headed to his clinic so many might have prescribed so many dos and don’ts to observe in his presence. All his questions are to be answered clearly. He would not tolerate anyone other than the patient answering his questions. Once, it seems when the accompanying husband of a woman was answering the questions put by him, Dr Rayudu was said to have dropped her arm and asked her husband to come over to the examination table, that too, in his 'military-tone'.

He was not the kind of doctor who would visit a patient at his residence—no matter how rich or socially prominent the patient was. He had his timings and within that scheduled time he would give the patients the time required for an “incomparably thorough physical examination”—inspection, palpation, auscultation and contemplation—and prescribe treatment—nothing less nothing more. It was perhaps to keep his clinic less crowded, he used to charge a little higher than what his peers were charging in the town. It must also be said that he was not totally averse to visiting a patient at his/her home if his/her medical condition was such that he/she could not afford to come to his clinic. If a patient happened to visit him without previous prescriptions, that’s it! He had it—he would simply be turned out for ever. 

With all these idiosyncrasies, he used to command patients’ respect—lots of respect, indeed— simply because he was true to his profession and importantly known to give the best medi-care. That makes me recall what my brother—a medico at that point of time—told on our way to Dr. Rayudu’s clinic: “He had all the medical qualifications that our AMC Principal had, plus one or two more.” Besides, what made the town talk so greatly about Captain Raydu was his professional integrity.

Our town had another humane doctor, Dr. Sunderramayya, who was just the opposite of Captain  Venkatrayudu in the sense—he had his medical education from Andhra Medical College, still rooted in his native ethos, particularly, not alienated himself from the rural masses—that patients and their relatives could feel at home in his presence, have a dialogue as though he was your neighbor, and, of course, get the best treatment. He was then hardly charging a Rupee as his consultation fee.  Perhaps, driven by the philosophy, “Good physician treats the disease; the great physician treats the patient” advocated by the father of modern medicine, William Osler, during his rounds in his 30 bed-hospital, Dr. Sundarramayya grasping the patient’s arm to check pulse would casually slide himself on to the edge of the patient’s cot and warmly enquire—just as a mother would enquire her sick son with all the warmth in the world—if he had good sleep the previous night. Spending with each patient for ten to fifteen minutes either in the form of clinical examination or eliciting information to evaluate the status of the patient, which was, of course, often couched under social enquiries, he tenderly gave them all the hope in the world to believe that everything was under control. It was this personalized dispensing of treatment that had created a myth among the villagers: “Dr. Sundarramayya’s mere palpation will relieve a patient from all his ailments.” 

Against these childhood memories of my native town, when I went to a corporate hospital a couple of years back to visit a colleague of mine, I had a shocking experience, particularly the narration given by the patient’s relatives sent a chill down the spine. And to be honest it was nothing short of what Dr. Sandeep Jauhar has had to narrate in his book: Doctored: The Disillusionment Of An American Physician.

In India too, hospitals are reported to be freely resorting to all kinds of “expensive, invasive and useless remedies”, of course, the only saving grace is: if one is enjoying the comfort of health insurance.   Here too, “the morale of doctors” is fast eroding. Doctors have no time to physically examine a patient. For, his income swells up only when he/she consults more number of patients. Or, the more the number of hospitals he/she visits in a day, the more the income. So, the tearing hurry is to get empanelled in as many hospitals as possible so that he/she could consult many more so that a day’s income could be maximized.

The other day a just discharged patient was commenting: “Earlier, we used to identify one as a doctor seeing him with a stethoscope around his neck. But nowadays, seldom you would see a doctor with a steth.   Any complaint, a doctor would jump to suggest ultrasound scanning/CT-scan/MRI, etc., but would never reach out to a patient for clinical examination.   And unfortunately, here too, “both doctors and patients have come to believe the higher the tech and the more the specialist you see, the better the care you are going to get.”

Hospitals are not shying away from sending their agents all around to scout for patients and encourage them to get checked by n-number of specialists and undergo unnecessary tests—all in their greed to generate more income.  And yet, with all such expenses, it is anybody’s guess if the patient is in any way bettered. Indeed, it is not uncommon to hear some visitors of hospitals accusing the hospitals, that too, loudly of keeping a cadaver on ventilator for collecting more rentals. And it is not uncommon in India too, to see hospitals striving to somehow better their occupancy rate by retaining patients in ICUs/ special wards unnecessarily for prolonged periods. Overall there is a strong belief that Indian medical professionals too are in no way inferior to their cousins in the US in doctoring more income to hospitals. 

As the cost of medical services are thus shooting up all around, that too, for no valid reason, Dr. Jauhar’s book sounds quite timely—“his describing eloquently the excess and dysfunctions of patient care and the systemic distortions responsible for them” is, as Dr. Stossel of Harvard Medical School observed, in itself a great service to the system. But the big question that remains unanswered is: Would it sensitize the system to introspect and correct itself?

I think, all is not lost, for even today there are good doctors whose concern always stayed glued to patient’s welfare—after all nobility is not time-specific. On the other hand, medical care today is definitely much, much better than what it was 50 years back. So, what is needed is: fix the critical questions raised by Dr. Sandeep Jauhar. India too has to look at these issues, for it is no exception to this growing malady.


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