The Challenges before a Christian doctor

We are looking at the challenges faced today by a Christian doctor but just for the sake of clarity; let us define who is a Christian doctor any way! Is it some one from the Christian community? Some one who studied at Vellore or Ludhiana or some such institution? Is it some one who works in a mission hospital? Well it could be and often is some one who is one and more of all of these. But these things alone do not entitle one to be called a Christian doctor. There is more to it. The basic definition is whether the people who call themselves Christian doctors practice medicine in the spirit of Jesus? There is the story about Sadhu Sunder Singh that once when he was visiting London and called to see some one , a little boy who opened the door , took a look at the Sadhu and then went back to his mother to say they had a visitor. When asked das to who it might be, the little boy replied that he didn’t know, but it was some one who looked like Jesus. It would be nice to be described thus – that Dr so and so looks like Jesus – not in the sense of physical appearance since we don’t know what Jesus looked like of course, but in terms of an inner likeness. What does that mean? It is important to study what goes into the making of a Christian doctor, because the challenges they face and how they try to deal with them is all tied up with that identity.

What makes a Christian doctor?

A good Christian doctor: has good training, keeps current in what he does, is reasonably caring, is as thorough as professionally needed, and is helpful to the patient. He exhibits common sense, wisdom, and decisiveness, though being willing to admit to it when stumped; and he is willing to direct the patient to second or other opinions or specialists. In short, he/she does as he/she would have it done unto himself/herself (the Christian "golden rule").

But what makes a doctor Christian is not only all of the above or a set of well founded doctrines he or she professes or the church background they come from or whether or not they serve in a mission hospital--- but whether a person is clear about his call, wherever he or she may serve. It is possible to be living with integrity in a secular setting as well as build kingdoms and practice intrigue in mission settings. The call is important. Indeed , it is the sheet anchor of any life – and when things are unclear as they often are , when ethics are changing , practices are changing , values are changing and changing fast , it is one’s calling that one holds on to , that provides the consolation and conviction and the ammunition to meet the challenges as they come.
As I talked to several doctors about the challenges they face in their professional life , I found this one thing in common - the challenge is not from the context alone – remote, lonely mission hospitals – under paid, under equipped and unrecognized, important as they are but to live and serve in the spirit of Jesus , in the place they are , doing what God wants them to do and find fulfillment in the work that has been uniquely been given them to do , when all along , many others including close friends and batch mates perhaps are finding it in some place else. If this is the expectation, what are the challenges?

Ethical Challenges:

In the public domain, the Christian voice is often muted on most issues of public and social importance. But there are a few areas where this voice is loud enough to be termed a noise - talk of stem cell research, cloning and euthanasia and abortion and there is lots of discussion on these things- though largely initiated through Western Christian doctors and scientists and activists and often not interpreted adequately in Indian terms. For instance take abortion. The abortion debate in the West for instance is all about a woman’s right over her own body and the right she has to choose to have or abort the baby. The issue of abortion and a Christian response and stand towards it is as important in India as else where – except that in India most abortions happen not because women are choosing to have them and are happy about them, but because it is not a decision they make – it is a decision that often that their husbands make or their in laws make. Or if at all a woman makes them, she does because she is cognizant of the social realities she will be confronted with if she chooses to keep the baby.

When our Christian doctors blandly refuse to do abortions, and turn women away as is also the practice in the West, they are often consigning the woman to a hellish existence. A Western woman has the option to choose and act in several different ways according to her conscience; mostly she has the economic independence and the required social space to do so. An Indian woman often doesn’t and her rejection by a Christian doctor often means that she will still have to have the abortion any way, pressured by her family – except that now she will probably have it in some dinghy ghetto and die of septic abortion. No body has thought that as we are Pilate like cleansing ourselves of the unborn fetus’s blood and patting ourselves on the back, we are taking on ourselves, the blood of the woman who might die of septic abortion or hemorrhage or many of the other complications that go with unsafe abortion.

The answer is not to say, that we must reverse our position and do abortions from tomorrow. But the point to me made is that in most ethical situations, we take our stand and practice straight from text book situations in the West when the societal realities in India are quite different and the challenge is that no one has thus far unpacked these ethical matters for us in Indian setting and therefore artificial constructed responses are more likely to be seen as fundamentalist rather than humane and compassionate.


Drugs and prescribing practices

Continuing education is a challenge to any one these days with changes occurring rapidly , newer drugs coming into the market thick and fast and the enlarging scenario of not just drug competing with drug but also brand competing with brand.. The ubiquitous medical representative is increasingly playing a multi faceted role in a doctor’s life – be it in providing academic supplements and literature, sample drugs, sponsoring family vacations in exotic locales. Brand recalls are created by excessive and often unethical visibility. Since the drug companies are not in the charity businesses, the costs of these freebies are written in the drug pricing, adding to the already burgeoning costs of health care. This strategy also ensures that lesser players or makers of generic drugs who can not afford lavish gifts but can afford to supply drugs at a lower cost fall out of the market. Prescriptive practices invariably come under challenge as a Christian doctor is constantly under pressure to conform as most others do. This often proves difficult and many succumb. An added dimension is not just that of prescribing this brand or that but that of prescribing out rightly irrational drug combinations, some of which might be banned in several other nations with a more aware and alert enforcement machinery.

Closely related to this is the matter of sponsorship of medical conferences, seminars and symposia. Prima facie, there is nothing wrong because these are professional fora where people come together to share, learn and network. All of this is good and necessary. The danger is in the hidden strings attached in the form of endorsements that professional bodies often end up giving to products of their sponsors and the issue relating to the conflict of interest in a pharma company sponsoring a program where the attendees are those who would then be prescribing their products. In short, one is being invited to suspend professional judgment or at least compromise it and go by the recommendations of the pharma companies. Some people say that they will attend these conferences but use their own judgment. Is this really possible on the long haul? If one chooses not to go, then one loses out on the professional benefits that accrue out of attending such events.

The allure of glamour

The medical profession is hierarchical. So are many sections of the church. But we can not conceive of a situation where the clergy has only Bishops but no priests. But that is precisely the lot of the medical profession where every one, who is anyone is a specialist and this is a prescription which we Christians have willy nilly absorbed in toto. The question of call is relevant here again. Instead of Christian doctors asking the question of what they are required by God to do in life and then asking the subsequent question of what they need in terms of training and equipping , Christians like any one else decide their own agenda , what they will study , where they will study and then build their career and future plans around this. It is not unheard of for students to sit and prepare for two and three years in a row to get a PG seat in a subject of their choice speaks volumes for the rat race this whole game has become. While God welcomes hard work and healthy ambition, is a rat race Christian?

In our parent’s time or our grand parent’s time, the first port of call for a sick person was the G.P, the family doctor to whom all turned for succor. He kept track of all that went on, arranged referrals, deciphered complex medical jargon to the patient and his family, provided comfort and his consolation saw families through grief and bereavement. Today that institution has disappeared. GPs were accessible, affordable, and available and provided personalized care. Today that space is captured by all manner of quacks that provide treatment of questionable quality at the door step. While it is considered socially appropriate to decry them by running anti quackery campaigns, it is worth recognizing that they occupy this space because the GPs who once occupied this hallowed space have vacated this space and the GPs that do exist, almost do so by default not having passed the PG entrance exam and are so aware of their de glamorized state that they exist in a shadowy world with a ghost like existence with low self esteem and little of worth to contribute. Sadly, Christian institutions have been second to none in glamorizing post graduation and holding it up as a goal ideally to be pursued by all by the simple expedient of treating non specialists so shabbily that every one wants to be a specialist, irrespective of whether they have the aptitude for this or not.

Conclusion:

The definition of a Christian doctor will keep changing and we only keep changing it so that the definition speaks our language and vocabulary. A Christian doctor is not necessarily one who practices in some remote mission hospital forgoing comforts, affluence and recognition. It is possible to live with far greater comfort in the confines of a mission hospital with lots of people to fetch and carry for you and many doctors live like kings of the mission compound and lords of the manor. The challenge always for a Christian doctor is whether he or she is displaying in his/her life and persona the virtues and character of Christ. The main feature or characteristic of Jesus was and is that He is accessible to all. He is an inclusive God and Healer. Are we? Through our pricing, through our hierarchy, through the way and manner in which we have structured our practice, the aura we are surrounded by as well as by our physical availability, have we distanced ourselves so far from the ordinary patient that only a select few and that too often from the elite classes can approach ? The caliber of the institutions we trained in, our sound professional competence, even the low fees we charge and the quality of care we provide are all irrelevant if we are not really accessible in full measure. It was said of Christ, that he left his heavenly glory aside when he came down to earth, so that ordinary people like you and me could see him, touch him. Can that be said of us?