Saturday, June 25, 2011

CONFESSIONS AND REMEMBRANCES: July 1994... By Dr Leong Shown Chong

By Dr Leong Shown Chong, Kota Bharu, Kelantan

For 6 ringgit I obtained a treasure – how I love to browse through and search for these bargains at the University Book Store back home in Petaling Jaya!

William Osler’s  “A Way of Life”  – discarded, unread, unloved among a pile of scattered, sorry-looking old books in its discount section. And who knows or cares about William Osler? Except me perhaps, and Danaraj surely!

And now when I read through Osler’s writings I have come to know better the truer measure of the man Danaraj is. Stirrings of familiarity, and a clearer understanding of the path that he has trodden, that he showed us, his students. I now appreciate better his reasons and his philosophy that guided him as a physician, teacher and friend.

But he is so far away now from us, sitting alone, dimly aware, while the advancing years snatch his presence away from us; while he suffers the very ailments he prayed his students would be delivered from – “may you never be sclerosed or thrombosed”; while his students forget his precepts and prayers.

Now he reminds me, and will always remind me, of a world past, where men – physicians- were well-read, keen of mind and body, commanding the world in science, ethics, art and philosophy. I feel sad and depressed when I realize how far we have fallen behind, and worse still, bereft of history – we are arrogantly ignorant of the moral and intellectual decay we have fallen into.

We prefer to read not Osler, but the stock market reports, dreaming not of upholding the integrity and good name of our profession, but of joining the ranks of businessmen; believing not in the honed skills lovingly and painstakingly procured over the years of diligent work, but in the seductive powers of advertisement and marketing, for our professional well-being.

We started out in our careers seeking wisdom but ended up believing in cleverness; we take the short-cut and not the long-view; we prefer the noise and action of the marketplace and not the silence of contemplation.

Indeed, just recently a prominent doctor, a cardiologist no less, “conceptualized” himself to be on par with motorcars and toothpaste in the local press! I quote “If advertising and marketing are allowed for every product from toothpaste to motorcars, how then did it become excluded from medicine and the law?”

And this, 150 years ago, Osler had already warned against! “Do not be given over to Bacchus, Aphrodite and Circe! Do not exchange a noble profession for an ignoble one. From physician, motivated by the patient’s best interest, to businessman, motivated by his own best interest; from physician, revered by all men, to politician, despised by all men! “

But perhaps we are only players on a much larger stage after all – the world has become a marketplace, and businessmen are held in much higher esteem than scholars in these days where research is a profit-directed activity, where the quest for profits overrides the questions of ethics, where ideas are shared only on payment of a sum….and what are we poor misguided renegades, except mere hapless pawns, in a much larger game?

There is an inexorable march towards the marketplace, in all spheres of our lives, summoned imperiously as we are by the God Mammon himself – while all around him, the high priests and priestesses sing of the false heaven of His, incessantly, seductively, and shrilly. These are men and women of the market, and as they come, they come in all manner of guises. We have doctors among them too. “Medicine and Law are in fact (profitable) businesses, a part of the huge service-orientated industry.”

The signs are unmistakable – the emphasis on GDPs, Commodities prices, Stock-Market charts, the labeling of Medicine as an Industry, the intrusion of private profit-seeking Insurance companies positioning themselves as middlemen between patient and doctor, the profusion of advertising and marketing gurus, the oft-quoted bottom-line, the prominence given to businessmen – these are in the forefront of the news, TV, magazines and films to the exclusion of rational thought and healthy debate. All else has become secondary.

And who has not been taken in, even momentarily? In the wake of this ‘money-worship’ the casualties litter the earth – the devastated environment, the suffering peoples, the purity of sports, the ethics of our professions, the decency of our lives…and still we march somnambulistically along, as the propagandists convince us that all is well, that we have progressed, the future bright, that we must become more business-like. And many of us choose to believe them.

The values that Osler and Danaraj spoke about have increasing relevance in these troubled and confusing times, to our profession in particular. When we have gurus to advise us to invest in the stock-market, they have advised us to invest in life-long education, that touting should be confined to horse-races and not patients, that our patients’ interests must come first before that of any others, that the only advertisement that doctors need are well and happy patients; to do good; to do right and to maintain a proper dignity at all times, eschewing the weariness of spirit and flesh.

What then, will I do? I know what I can and will do; what I am unable to decide upon as yet is whether to come forward and say my piece openly, to provide an alternative point of view; hoping that there will be enough physicians out there willing to reconsider and return to the enduring foundations and ethics of our profession.

Do I dare? Do I care? I should because I owe this much to the teacher who had taught us so well. Then I shall turn from the marketplace and live among men like him and Osler. It would be such a difficult thing to do – their stature dwarfs me!

I would have my own little private life, my own little private kingdom; take my pleasure in letters and literature, and in the joys and satisfaction of the profession.

I would take my practice beyond the scope of the marketplace! Indeed, the results of this may impoverish me, but let the patients, if they have the health, the heart and the wisdom, advertise for me!

For me I shall revel in my own satisfaction for a race well run, for a life well-lived, ran and lived on my own terms, and not dictated by the whims of the marketplace!

Yes, I remember! And it is good to remember Osler and Danaraj!


loonshin said...

I have in my library, the book, Osler -- inspirations from a great physician, by Charles S. Bryan. The teachings of Osler and TJD continue to guide and inspire me.

Dr D Quek said...

I have "A Way of Life' by Osler too. Re-reading it. Looking to purchase his other books... great man! Pity that Danaraj did not write much about his philosophy that we can appreciate much more of... But some of his students are now hoping to relive and reignite his concepts and undiminished teachings...

Born Of Grace said...

Dr. Quek, I am nobody of significance, a mere 2nd year medical student in the midst of thousands of blinded, self-concerned, misguided students all engrossed in getting themselves an MBBS from any local university willing to hand it to them.

But thank you for this post on your blog, and to Dr. Leong as well. Indeed, I was rather disillusioned because the culture amongst medical students today is an ahistorical practice of medicine. Nobody cares about Osler, or Cushing, or Laennec etc anymore. Nobody holds the practice of medicine as an ethical calling, or appreciate the rich philosophy from which medicine was first derived. Medicine today (at least in Malaysia) teaches us to be cold machines of professionalism, which is sad. But also, perhaps, my generation is more self-absorbed and individualistic than any other.

So, thank you for reminding me that there are others who still believe in the practice of medicine as did the forefathers of medicine.

Dr D Quek said...

Dear Born of Grace, you are certainly not insignificant. The very fact that you have bothered to read beyond the usual medical books, means that you have that something special and rightful ambition to be a doctor of substance. Yes there are many physicians out there still who practice very ethical and meaningful medicine, don't give up yet in you early days as a med student. I do hope there are some good teachers out there still, hopefully many in yours! BTW you write well for someone so fresh in the profession, and I truly mean well for you and your future!

Hee-Ong said...

Dear Dr Quek,
I am not sure if you have seen the book "TJ Danaraj: Doctor and Teacher Extraordinaire" ?
This is in response to your earlier lament that it is a pity Danaraj did not write more of his philosophy..

Dr H O Wong