By SAURABH JHA, MD

Recently, my niece gingerly
confided that she was going to study engineering rather than medicine. I was
certain she’d become a doctor – so deep was her love for biology and her
deference to our family tradition. But she calculated, as would anyone with
common sense, that with an engineering degree and an MBA, she’d be working for
a multinational company making a comfortable income by twenty-eight. If she
stuck with tradition and altruism, as a doctor she’d still be untrained and
preparing for examinations at twenty-eight.

Despite the truism in India that
doctors are the only professionals never at risk of starving, the rational case
for becoming a physician never was strong. Doctors always needed a dose of the
irrational, an assumption of integrity and an unbridled goodwill to keep going.
Once, doctors commanded both the mystery of science and the magic of
metaphysics. As medicine became for-profit, the metaphysics slowly disappeared.

Indians are becoming more
prosperous. They’re also less fatalistic and expect less from their gods and
more from their doctors. In the beginning they treated their doctors as gods, now
they see that doctors have feet of clay, too. Doctors, who once outsourced the
limitations of medicine to the will of Gods, summarized by the famous Bollywood
line “inko dawa ki nahin dua ki zaroorat hai” (patient needs prayers not
drugs), now must internalize medicine’s limitations. And there are many –
medicine is still an imperfect science, a stubborn art, often an optimistic breeze
fighting forlornly against nature’s implacable gale.

As their sheen recedes doctors face
a new tide – mob attacks for undesirable patient outcomes. The strike by
doctors in Calcutta in protest of a junior doctor seriously injured by an angry
family of a seventy-five-year-old patient who passed away, is just the tip of the
iceberg. There’s more trouble brewing.

As people are living longer they
have more diseases and are on more drugs. Medicine has become more

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