SUSRUTHA’S OATH AND MODERN DOCTOR’S DILEMMA

SUSRUTHA’S OATH AND MODERN DOCTOR’S DILEMMA
Dr Suvarna Nalapat
Susruthasamhitha says that the Guru should obtain an oath from the disciple before he takes the student as a Medical student.The oath is for sacrificing all his Kaama (likes and dislikes and dualities) greed,anger,ego ,envy ,violence,untruth and dishonesty ,and all his base qualities ,laziness and artificial acting of greatness . Only after testing the Disciple for these and getting an oath from him/her the Guru gives Upanayana to Medical Profession. This was the Forerunner of Hippocratus oath.
Thatho agnim thri:parineeyaagnisaakshikam sishyam brooyaath
Kaamakrodhalobhamohamaanaahamkaarershyo paarushya
Paisoonyaanrithaalasyayasasyaanihithwaa neechanakharomanaa
Suchinaa kashaayavaasasaa satyavratha brahmacharya abhivaadana
Thathparenaavasyam bhavithavyam madanumathasthaanaanagamanasayanaasana
Bhojanaadhyayanaparenabhoothwaa mathpriyahitheshuvarthithavyam
Athonyathaa the varthamaanasaadharmo bhavathi
Aphalaa cha vidyaa na cha praakaasyam praapnothi (Soothrasthaanam 2.6.Susrutha)
According to Hassler who translated Susruthasamhitha to Latin ,Susrutha composed his great work in 1000 BC .When Hippocratus borrowed the code of conduct for the doctors ,he was echoing Susrutha for the welfare of the patient so that the patient is not harmed by the Doctor’s personal dualities,greed,and other base qualities .
When I read D.Balasubramanian’s article in the Hindu ,I thought of this Sloka in Susruthasamhitha. (The Hindu 8.9.2011) He speaks of two hypothetical scenarios studied by a team of sociologists and doctors (Archives of Internal Medicine April 2011)
Scenario 1:- Imagine that the patient/doctor has colon cancer .Two surgical options are available .Both has 80 % success .One had the remaining 20 % persons developing side effects (4 %) and death(16%).
The second has no complications,but failure was 20 % and for every 100 persons operated 20 die.Of 500 doctors interviewed ,242 only responded showing the lack of involvement of the doctors,or their lack of opinion .Majority of doctors chose the second option for themselves. 60 of 242 chose surgery 1 for their patients.So ,there is a dichotomy for what they choose for themselves and for the patients.
Scenario 2: - Imagine a flu epidemic.There are two options. Mode one is simple hospitalization ,bed rest for one week .No intervention at all. There is 10 % mortality. Second is with a newly introduced Immunoglobulin . The adverse effect with Influenza virus is cut to half(only 5 % mortality) but complications due to Immunoglobulin like paralysis (4 %)and death (1%).
1600 Primary care clinicians were asked which options they will take for themselves and for their patients. Of 1600 only 698 responded. 440 doctors opted for hospitalization and bedrest for one week (without new immunoglobulin) for themselves.258 prefered immunoglobulin for themselves. 386 doctors preferred Immunoglobulin treatment for their patients.
In both the scenarios the doctors preferred the option for a high mortality rate for themselves ,to avoid adverse reactions affecting their day to day activity and quality life. But to their patients ,they preferred the other option .
Reasons: 1.Less harm to patients is interpreted as less mortality rate .This may be to prevent law suits.A defensive method
2.Psychological cognitive bias . People when they recommend for others focus on single dimension alternative ,that is typically easier to defend.
3 .For themselves they have several biases coming into play.One is the feeling that intervention to prevent harm is worse than the harm caused by illness itself.(Betrayal aversion)
4.Omission Bias: Harm resulting from an act is worse than not doing it at all. Omission better than commission.Both 3 and 4 are cognitive biases and of the 3 cognitive biases the safe and easy defense is applied for patients(whom they consider as the other) while they take the other option for themselves.
5.It is probable that the doctor thinks that the life of patient is saved first ,with complications,then later on the complication treated slowly with other methods in time .This saves the life.
The dilemma of the doctor is shown perfectly well in the article.The question is if one prefer for oneself is a quality life , and prefer mortality to an invalid existence- why doesn’t one think that the patient also may prefer such a life ,rather than an invalid disabled life at mercy of others? The duty of doctors thus is to inform the complications and the different options-not only in allopathy but in other modes of indigenous treatments available –and respect the patient’s preference for selecting his/her own options for treatment. If this method is adopted and all the different modalities of western and Indegenous medicines are made available in the same Hospital (institution) the integration of Medicine will be perfected and made more efficacious.This is what I envisage when I link and integrate Allopathy,Yoga,Ayuveda through the golden link of Music Therapy .The Integrated Medical practice has to come up for solving several dilemmas the doctors ,patients and the nation face for cost-effective quality healthcare . Integrated Medicine does not mean one branch of Medicine adopting the style and theory and practice of another branch,but it is a client-centered approach where all modalities of treatment are presented to client and his/her relatives under one single roof in a co-operative manner .Therefore there is no need for any branch of Medical knowledge to loose its originality or to fear that the other may take away its practice.This dilemma of practitioners is the main stumbling block at present in integrating the Medical practices efficaciously at present . The nation needs an efficient and cost-effective integrated approach for healthcare and for that each branch of medicine-both western and indigenous-should contribute in co-operative way . The first step for a healthy nation is having best nutrition (for which promotion of agricultural practices according to the geographic peculiarities is essential)for all its children and adults,best education (free education at least upto the higher secondary level) ,the awareness of Nationalaty and a good citizen’s duty along with rights,and a job for at least one member of the family .The other things are control of alcohol,drug intake and other social evils so that the brain of every citizen function normally .What we think we say and do and become. Therefore a healthy body and a healthy mind is needed for healthy intellectual life of the nation.Without these preliminary requirements ,mere multispeciality hospitals as business centers which can cater to only the needs of the wealthy people cannot protect the national health or its health policy.