In search of Diagnosis – The PSM way

In search of diagnosis…

(On the occasion of Corona and IMAs cancelled candle protest)
As Covid 19 pandemic has taken over toll of entire world many of us are getting familiar with few terms like Community spread, social isolation, stigma, mass vaccination etc.Most of this terms are quite frequently used by Public health experts/Preventive and social medicine expert. If few of you don’t know then let me explain what is Preventive and social medicine….? It is one of the most important but most non glamorous, most neglected and most underrated subject in medical curriculum. In fact not only students but senior academician/consultant/big specialist doctors gives least importance to this most useful subject. When the whole world is in shadow of death then if any medical subject which is helping us most to survive is ” Preventive and Social medicine”.

Preventive and social medicine is consider as non glamorous subject amongst medical students because they are wrongly informed that you can save peoples life only after doing or performing skilled complicated procedures in highly equipped ICU set up/operation theatre in big city hospitals. Preventive n social medicine(PSM) focuses on various aspects of illness like prevention,sociology, psychology,economics, geography, politics etc aspect of disease. On other hand other specialities of medicine concentrate only on biological cause of disease and treatment of that disease. This specialities hardly concentrate on things like weather this diseases can be prevented, weather treatment is cost effective or accessible to weaker section of society or community can be involved/educated to deal with disease.Doctor working in rural/remote area with limited resources still can save thousands of lives with simple medicines of malaria, anaemia, malnutrition etc. Treating this simple(but risk of dying)patients doesn’t involve much adventure and heroic feeling for young doctors which they may get while saving few old patients in ICU or operation theatre. Now time has come for young doctors to decide weather they want to run behind heroic feeling or save millions of life at primary level.
Neglecting social discussions while learning and dealing with health is quite common and historic because obvious reason that those who became doctors in past(and present also) came from very privileged background. In fact still now first criteria to became a doctor is your privilege urban background. As most of this doctors are from city and either rich or middle class background they fail to understand health problems and solutions through social angle. Health is surrounded by many things like poverty, education, superstitions, politics, social hierarchy, beliefs of community, accessibility of services etc but sadly we learn health with tunnel vision of focussing only on some symptoms of disease and few drugs. As young doctors fail to understand complexity of this health sociology and psychology they gets easily frustrated with societies violant reaction to health inequality. Innocently they ask only for security and few laws to punish people who harass health workers. They don’t want to take efforts to understand this complex psycho- social-political diagnosis of current difficult health situation.Time has come for all of us to unlearn and relearn many concepts of health we learn in medical colleges. We urgently need some strong structural changes in our medical education.
Post independence when first generation of doctors started giving their service in rural areas in early 1970s they got highly frustrated because they found that whatever knowledge they gain in big medical colleges was of no use( or less) to treat diseases in community. People can not afford medicines and even food. Superstitions and lack of awareness were much bigger disease than many others. To understand this complexity few like minded socially sensitive friends started group called ” Medico friend circle”(MFC). This highly intellectual group consist of many socially sensitive people from different educational,social and ideological background. Since last 50 years MFC has taken stands, participated and contributed in many health issues. In 1977 MFC published one very interesting book called ” In search of Diagnosis”. It is collection of many articles on public health, it’s limitations and solutions ahead. Even after 50 years of it’s publication many things(specially medical education) doesn’t changed so this book is still very relevant to understand present public health situation in light of corona.
Main weapon while fighting corona pandemic is physical distancing and not any complex medical drug or procedure. Many of you may think that then weather other specialities like surgery, radiology, skin, medicine etc are of less importance..? Obviously not… But they are of less value without community health approach and will be restricted to only few privilege people of society.We just need to add community approach to our existing specialities so we need more community dermatologist, community cardiologist, community surgeon, community dentist, community Vaidya, community homeopath etc.
If you want to save few thousands lives then go with only clinical approach but if you want to save millions, billions or entire world then go with community health approach.

Nilesh Mohite.
Community Psychiatrist
Assam

P.S- Few months back I was attending one state level conference of Psychiatry. I hardly attend such conferences because of some obvious reasons. We had many senior n intelligent Psychiatrist conducting highly intellectual and informative sessions. For 2 days we discussed about many newer medicines and ” Drug of choice for that particular disease”. The conference was about to end and everyone was busy in appreciating about content n speaker of conference(indeed it was good). To my right hand side one very senior government psychiatrist was seating. I asked him ” So sir which will be your drug of choice in this condition…?”. With smile he replied ” Whichever medicine Will be available in government stock(if any)”. Same question I asked to young city psychiatrist seating my left side. With despair he replied ” I will prescribe if I will get any patients” ( still with lack of awareness n superstition very less people visit psychiatrist)….and obviously we didn’t discussed anything about this two important things in that highly intellectual conference.

That’s why I always feel that we have to come ahead “In Search of real diagnosis”…..

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