Articles

MEDICINE-YESTERDAY, TODAY AND TOMORROW

DR. P. LAKSHMANA RAO

Ex-principal

Guntur Medical College.

            On this very happy occasion, when this Guntur Medical College has come off age enough to celebrate the Golden Jubilee Year. It perhaps is the time to ponder over the past with an eye on the future. The changing trends in the medical care stand as a witness and are a testimony to the advancing frontiers of Science in general and Medicine in particular. Medicine no longer can stand on its own pristine golory of being an art without accomodating scientific aspect of it. The every daypractive of Medical care is a reflection of Medicine as a science as it is practised now. In fact, a small example would make this point clear. About 30 years ago, it was considered enough that to make

A diagnosis of heart disease, basic skills of history taking a well trained auscultation after percussion and correlation of the signs and its symptoms necessarily coupled with a skiagram of the chest and a 12 lead Electro Cardiogram, were all that is necessary to arrive at a tangible diagnosis- a diagnosis sufficient enough to understand the Haemo Dynamics and to give us an idea of not only the diagnosis but prognosis as well. So was taught to the medical student. This scenario has undergone quite a considerable change. To quote from the same example, now it is necessary perhaps to know the results of invasive procedures like cardiac Catheterisation with its pressures studies in various chambers, a non-invasive application of electricity in understandibg the diagnosis of not only arrythmisa but also the instruments like the defibrllator, pace maker and a host of other instruments that have come to be routinely used in the cardiiac Care. Sub specialities in  Cardiology like Interventional Cardiology, the new techniques lke P.E.T. have added a new dimension for understanding the altered Physiology of the heart and the blood vessels So much so, the modern medical man has a larger amount of data at his command to help him, hypothesize, theorise, collect and plan a very systematized elective procedure (procedures) for the various cardiac maladies that confront the human being. So much So, if you used the words ‘now’ and ‘then’, the abive quoted example is an abundant illustration of how advances in the vast field of medicine has necessarily changed the very practice of medicine and it can no longer be an art alone any more. It has to be a mix of Physics, Chemistry, Pressure Flow Studies and Anatomical variations that are visualised by non-invasive teachniques as well. Man’s ingenuity in dealing with the altered sub states has not lagged behind . It is abundantly illustrated in the advances in the field of treatment of I.H.D. by the evolution of cardiac angiograms, angio plasties, insertion of stents and also many other synthetic materials  as well . The list will be too long to state over here. Suffice it is to mention that the newer developments though appear to be complicated on the surface, are un-complicated when viewed against the tenets of modern science.

            This takes us to the basic alterations that are required very badly in planning our new strategies for the under graduate medical education, its curriculum, its examination systems and the very methods of teaching as well. The strategies for the under graduate medical education, its curriculum, tis examinations systems and the very methods of teaching as well. The evolution of the computer with its facility of simulation as a technique is not still being used in our centuries. How nice it will be if we can develop the usage of a compute in utilising it for computer Aided Designs (C.I.Ds.) and Computer Aided Models in demonstrating to the student of the altered physiology Vs. the Normal Physiology in displaying, as it occurs in health and disease. In fact, the way we have been learning and teaching our lessons in Anatomy and Physiology, however solid they may be, are at best archaic. We can always produce a Three Dimensional model of the human body wtihout necessarily wielding. Scalpel and dissection of the dead body as it used to be. A new dismenion of understanding the structures in the human body as it used to be. A new dimension o uderstanding the structures in the human body Viz. The depth of the tissues, the state of the interior from the exterior by computer vision ads to new modern dimension for understanding human anatomy. Perhaps, we have come to the stage, where the Anatomy Museums that occupy vast spaces in our Medical colleges can be utilised much better and replaced by modern methods.

            Even the way Medicine  taught, where essential contents of medicine are delivered by the Teacher in the so-called class room, lectures must receive some attention. It is no longer accepted that a teacher and the student are the ones that require application of all modern methods that we have. Some of the slides that are made with the modern aids can be taken home byn the students, be it Anatomy or Pathology or altered Physiology and l;earn at home with a very comfortable background of his own home and comprehend things better thanthe most un welcome teaching room or the lecture gallery. It also dispenses with the studdnt suffering the experienced of receiving from the teacher, what is written in good language in the book, in a crud language. In other words, an attractive written material in the book is presented by the teacher in a very un-welcome atmosphere and in a very un-gramatical language that can neither be called aprose, much less a poetry. This places an extra burden on the student of un-winding of what he has learn in the class room, to learn from the books at home. So much for the dire need of changing our technology of communication between the teacher and the taught, as early as possible.

            A word about our libraries, they are no longer the places where you can learn anythging relating to medicine. The Text books are as old as they look, as they were edited and written long long ago.  The  budgetary constraints have truncated the libraries and they are now archaic exhibits. If you go to a library of any Medical College, Particularly in Andhra, it is like going to an Automobile Exhibition and looking at the vintage car rather than the modern exhibits. In fact, the remedy is easy, but it looks as if, we do not have the political will to do it. It is not because of lack of money alone. But it is the lack of the Will. Series of students have passed from this Medical College, Acquitted themselves with every one that their growth potential is vast and multi-identsional. Thus they are welcomed in every country, where they have gone and their skills are not inferior to the boy and girls in various other countries, by comparison.

            In summary, it looks as if there is enormous room for improvements in various quarters. In methods of teaching, in selection of teachrs, in the content of Medicine that we teach, in the way we treat our students, in the way we conduct medical care all this can be done in much better way at much lesser cost, if there is political will. One wordof caustion, the quality of the student material is not strictly comparable to the ne that we handled some decades ago. The causes for such decline are to be looked into elsewhere. It is a challenge now for the Medical Colleges to locate the cause of decline, suggst the modern methodology and teaching the politician that we can do the job better and can deliver the goods better, if only we are allowed to.  The need for a rapid all roudnd change is too obvious.