Healing is an art developed over centuries of practice. Time was when the doctors had no access to scientific innovations. Technology was at a nascent stage. So was biochemistry. Research took years of painstaking studies. Even drug like Penicillin which is now taken for granted came into the market only in the early forties. A medical practitioner, under the circumstances, had to rely on his own clinical acumen and such medicines as were available and whose efficacy had been proven. Most of his practice lay in listening carefully to his patient'sproblems to arrive at a correct diagnosis.
It has been stated by knowledgeable sources that a doctor who took a careful history reached a correct diagnosis in 70 per cent of the cases. At least, that is the opinion of Dr Bernard Lown, author of this profound work. He is no man whose opinions can be ignored. He is a cardiologist of world renown, apart from the fact he is Professor Emiritus at the Harvard school of Public Health. A pioneer in research on sudden cardiac death, Dr Lown has been an inventor, besides, and co-founder of an organisation of international physicians for the prevention of nuclear war with a membership of more than 200,000 physicians from 80 countries. In 1985 Dr Lown accepted the Nobel Prize for Peace on behalf of the organisation. But apart from his high standing as cardiologist, it is his strong support to the human aspect of healing that has won him international plaudits. And this is what this work is all about.
It is Dr Lown'sthesis that important as sophisticated technology is, it is impinging on doctor-patient relationship which is to Dr Lown most important. As he put it: ?Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures.? He says: ?Doctors no longer minister to a distinctive person, but concern themselves with fragmented, malfunctioning biologic parts. The distressed human being is frequently absent from the transaction.? He attributes this to the introduction of increasingly sophisticated technology, with the result that at least some doctors believe that technology has become ? a sufficient substitute for talking with a patient?.
This has upset Dr Lown who has strong resentment towards doctors who treat a sick person ?merely as a repository of malfunctioning organs or deranged regulatory systems that respond to some ?technical fix??. The rot, he asserts, will continue ?until doctors recommend with their tradition as healers?. Dr Lown is not talking through his hat. In this, his endlessly fascinating and highly educative work, he relates, his own experiences with patients and how he frequently found way to help those in distress?patients with multiple problems?often with careful listening which he calls the heart of diagnosis. That somebody so high in his profession should sound sceptical about the many highly techno-oriented tests carried out in hospitals at great financial cost to the patient, speaks not only for his courage but also for his fair-mindedness. Dr Lown quotes another distinguished physician, Dr Samuel A Levine as having once hinted that ?frequent reliance on a so-called work-up, engaging the heavy medical artillery of the day such as X-ray or cardiac fluoroscopy, electrocardiography, phonocardiography, blood work and urine analysis is testimony to a lack of clinical skill.? A very damaging remark, but coming as it does from a physician of such international repute, worth pondering over. Levine apparently accumulated a ?veritable encyclopedia of small diagnostic clues that were generally related to curable conditions? besides having a genius for thinking up simple approaches for difficult problems.
Dr Lown'sobjection is to physicians downgrading or ignoring psychological and social impacts of illness. As he put it: ?While medicine was once a professional calling, it has increasing become a technocracy, focussed on dysfunctional organs and ?the patient as an ailing human being is no longer the physician'sprimary concern.?
The important thing is that Dr Lown is not talking in the air. He is talking from experience. And he details numerous incidents in his long career, following his own principles with excellent results. As he put it, ?what health care demands is medicine with a human face.?
This book was originally published in the States but this is an Indian edition and he has contributed a special introduction to it in which he claims that years ago he founded the Lown Cardiovascular Group, consisting of five cardiologists who practiced ?a distinctive type of medicine?. What was it? Its distinctive element was that all of them ?spent time with patients? and learnt that ?unhurried listening is the most cost-effective measure available to promote better health?. The more time invested by the doctor at the outset, the more satisfied was the patient and the more trusting the emerging relationship. Thereby the physician was enabled to become an effective advocate for a healthy lifestyle. One would not know how many Indian physicians and surgeons would agree with Dr Lown'sthesis. It is not that Lown is opposed to high cost testing. He is only too well aware that in certain instances, such testing would be necessary.
Dr Lown is not afraid of admitting some errors that he had committed and he is honest enough to say where he might have erred. But when he narrates case after case where, following the principles he outlines, turned out to be successful, it is hard to question him or cast doubts about their value. At one stage he introduced a drug called Lidocaine to shut off irregularities in heart rhythm. This was through sheer chance. But it turned out to be such a tremendous success in resuscitating patients with cardiac arrest that the sale of the drug skyrocketed and people were recovering fast. The only unhappy consequence, admits Dr Lown slyly, was that he lost an entire team of good nurses who were masters of the art of resuscitation!
This is not a book meant only for doctors. Laymen would enjoy it even more for the stories told of how cardiologists function and are often so dependent on hi-tech tests when they don'thave to be. Here is a physician relating his 45-years of experience with literally many thousands patients. For drawing attention to the lost art of healing, one can'tthank him enough. His thesis is that one doesn'thave to abandon the spectacular advances in modern science. But one should not forget a sensitive, humane, enlightened approach to medical care either. For that simple message, the entire medical community not to speak of the hordes of patients across the world should be grateful to him.
(Hay House Publishers (India) Pvt. Ltd., Muskaan Complex, Plot No. 3, B-2, Vasant Kunj, New Delhi-110 070, India.)
