Death of General Practice and the Rise of the Medical Mafia

October 7, 2011, 5:07 pm


by R. Chandrasoma

The care of the ill, the ageing and the congenitally handicapped was a burden shared collegially in traditional societies. Birth and death were regarded as climactic events that were cushioned by cohesive social responses. It is true that witch-doctors, sorcerers and soothsayers had a role to play but they were not part of an indispensable expert panel that demanded fees for services. In Victorian England, the care of the poor and the ill was seen as a basic duty of the manorial class – especially of the young and gifted women - who viewed this service as a high act of Christian charity. The acutely ill and the dying were attended by men of God (pastors and the like) who regarded healing in the broadest sense as a high duty imposed from above. The notion of ‘payment for services’ was abhorrent to them.

We know little about health-care and its attendant social institutions in ancient Sri Lanka but it is safe to say that charitable institutions of a like kind held sway in our Island. Sickness and death brought people together and the idea of making money out of the misery of others is surely an aberration that moralists in all societies will find repellent. This is not to say that that experts and paid services can be wholly dispensed with but to affirm its marginality when it comes to matters of basic existential misery. It is grotesquely unfair, surely, to pay experts a fee to beat off the bad effects of senescence. It is an outrage that heavy fees have to be paid to doctors and hospitals to ensure a ‘proper exit’ from Planet Earth. It is equally strange and disturbing that the birth of a human being is treated as some kind of affliction demanding the expert attention of paid professionals in sanitized wards.

The term ‘medicalisation of society’ has been increasingly used to denote the widely-seen distortion of humane medical practice into something driven by professional greed and the dictates of the market. This is the process by which natural afflictions of the flesh come to be defined and treated as medical problems, and thus come under the authority of doctors and other health-care professionals to study, diagnose, prevent or treat. Thus balding and the graying of hair is deemed pathological and is ‘treated’ (at a cost) by experts. A stout middle aged man is warned by an ‘expert’ consultant that he has high blood pressure, is a type 2 diabetic, has ischemic heart disease, has an incipient cataract and is threatened by an enlarging prostate. This poor man is now ‘medicalised’ and is enslaved to a professional class of ‘doctors’ who see weaknesses of the flesh as ‘market opportunities’. We speak here of the general trend and it is not our intent to denounce all doctors. It is the ruling paradigm of current medicine that good health can only be maintained by interventions – often costly and high-tech. The analogue is the motor-vehicle – which has to be serviced and rehabilitated if it is to be kept in good running order. This violation of the autonomy of a living person is such as to make the first duty of the medical practitioner to intervene and to treat aggressively a perceived machine-failure. This analogy with a motor-vehicle is apt. No longer is the human subject seen as an autonomous agent with powers of will and self-correction that must be harnessed in any holistic approach to healing.

A great partner in this debauchery of humane medicine is the Global Pharmaceutical Industry and its manufacturing arm devoted to instrumentation of a high-tech medicine. The general aim of all these players is to make treatment as complex as possible by the massive use of experts, diagnostic and operative machines, costly drugs and futuristic hospitals. The proximate aim is to make every perceived affliction a diagnostic nightmare demanding tests, interventions, hospitalization and - last but not least – enslavement to that species of helpless bondage that we called medicalisation.

We must ask a basic question – who benefits from this strange revolution in medical practice? It must be admitted that for the lazy rich and the profligate valetudinarian, this extraordinary medical service is a great boon. Is it the right way for the public as a whole? It is, of course, a way of life that brings enormous wealth to medical specialists, drug manufacturers, hospital owners, makers of CT-scanners and the like. An entire nation is now pathetically dependent on this extraordinary turn in the way in which medicine is practised. We are not against capitalist enterprise but view with horror the grand exploitation of the natural ills of mankind for the purpose of financial gain. This horror is magnified a thousand-fold when we see that care-givers – medical experts and consultants of all kinds – are at the forefront of this shameful game of ripping off the public in the name of medical care.

Let us turn to alternatives. The glaring and shameful fact is that doctors no longer treat patients in their homes. They (the patients) must travel to the sanctum of the high specialist who orders tests and uses a clinical algorithm to assess the condition of the patient. High-costing drugs are prescribed ad lib as we live in an age where the ruling belief is that diseases can be cured by the efficacious use of chemicals.If the condition is serious, the poor patient has no option other than to enter that high-charging hotel for invalids misleadingly called a hospital. There is a radically different approach to ill-health that refuses to fracture the basic connection between the patient and the domestic milieu, in which he lives – as part of a family and an inalienable nexus of close social relationships. The first rule of doctoring is to heal (which is not quite the same as ‘treat’) the patient in collaboration with the family by being part of the

 latter. The old-fashioned ‘family doctor’ had no great hold in Sri Lanka but it represents the best in humane medicine. The basic thesis is that illness – broadly defined – is a maladaptation best treated holistically by the doctor becoming part of the family circle that is near and dear to the patient. Much ill-health is factitious and huge sums can be saved (with corresponding diminution of specialist and hospital practice) if the aetiological assessment is done in the patient’s home with the help of those closest to him (or her).

The prime and useful conclusion to be drawn from these observations is that the usurpation of family doctoring and care by an exploitative capitalist system (best called a mafia) masquerading as the sole healing arm of society has had disastrous consequences. Not least of these is the very high cost of birth, survival and death. The richest countries in the world groan under the massive inflation of medical costs. For the ordinary poor, the rule is that the quality of treatment depends on how much you can pay – a travesty of the Hippocratic philosophy of healing. There must be a return to a system of doctoring within the family based on itinerant healers who are willing to be part of the family in times of distress. It is clear that the new generation of lettered specialists have no role to play in the humane scheme we have in mind. It is time to introduce ‘bare-foot doctors’ of the kind introduced by Mao in Communist China after the Revolution.

 The idea is to break the stranglehold of a system of medicine that vastly benefits the practitioner (and his capitalist backers) while ignoring the central theme of humane healing in the setting of family and home.