Ethics Of A Physician – Vaidya Vritti

By Dr Raghuram Y.S. MD (Ay)
A doctor’s interaction with patient is usually a professional matter. But Master Charaka advices to add a touch of love and compassion to it. Charaka has given earliest description of ethics to be followed by a physician. He has called it Vaidya Vritti.

Sanskrit verse

Below mentioned are 4 ethics of a physician.

Friendliness

Maitri- being cordial and friendly with the patient Karunyam arteshu – having compassion and sympathy toward patients Shakye Preeti – Favoring to treat the diseases that are curable. Prakrutistheshu bhuteshu upekshanam – not concentrating on diseases which are incurable, where patient is definitely going to die.

Maîtri –

Maitri means friendship. Physician should be friendly with the patient.
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Patients keep searching for a doctor who would hear to them, their problems, understand their problem and then give treatment. Owing to their busy schedules, some doctors might not get enough time to listen to the plight of their patients. This is causing general public to lose trust on medical community. Some patients come back from their hospital visit with an disappointment that their case was not heard properly.

According one of largest international studies on consulting time, published in medical journal BMJ Open 2017, doctor’s time per patient is just 2 minutes. (report)
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Countries and doctor-patient interaction time:

• India – 2-2. 3 minutes
• Bangladesh – 48 seconds
• Pakistan – 1. 3 minutes
• China – 2 minutes
• Singapore – 9. 3 minutes
• United States – 21 minutes (source)

It is a point of concern that around 50% of world’s population which includes 18 important countries has a latest reported mean consultation length of five minutes or less. This will definitely have an adverse effect on patient care and stress of consulting physicians. Shorter consultation time means less compatibility between doctor and patient, and also means larger problems in healthcare system. There may be many reasons like population growth, increased morbidity, over-crowded clinics and hospitals, busy doctors etc. But that doesn’t take away need of ‘hearing ears’ from a patient’s perspective. Comprehensiveness of healthcare system will be lost.
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Every year output of outgoing doctors from medical institutions is adding to availability of number of doctors available per patient. If a doctor is not finding time for his patients, it becomes unethical and there is no value for medical degrees and super-degrees because quality of healthcare is decreasing on graph.

What if doctors are trained to deal with patients in a friendly way, have time for every patient they see and limit number of patients they consult per day…at least if some doctors start seeing their profession in these terms, at least a few souls will be healed!!

Worthy scenario is to watch that elation on face of patient when he or she is addressed by their name. The feel of patient that ‘Doctor knows my name’ is onset of healing process.
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Empathy

Karunyam aarteshu –
Karunyam means compassion and love. Physician should be compassionate with patient.

I remembered an act from a Hindi movie named ‘Munnabhai M. B. B. S’ in which dean of medical college tells that physician should not have compassion and courtesy towards patient, they are just subjects. I feel that most of medical system does same.

A few words spoken with affection, a little care shown and a little assurance given will make patient feel even worst of worst problems related to health at ease. He starts feeling that there is definitely a way out.

Both above said principles i. e. being friendly and compassionate with patient will help in building rapport with patients. Patients will also reciprocate by being obedient and show more confidence. They would follow instructions of a friendly and compassionate doctor than otherwise. This helps in effective healing.
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Prognosis

Shakye Preetih –

If diseases are curable, physician should treat those conditions with dedication and love. This is an important thing which a responsible physician should remember. He should know his limitations. He should have a thorough knowledge about diseases, their stages, type of Dosha vitiation, extent of pathogenesis and severity, symptoms and symptom complex, prognosis and options of treatment available and non-availability of remedies for a given disease. He should be treating only curable diseases. For this, he should have a comprehensive knowledge and information about sadhya asadhyata i. e. prognosis and criteria for deciding prognosis of disease.

Once nature of disease has been decided and once physician comes to know that it is a curable disease, he has to put all his efforts in curing it. He should dedicate his time and skills towards breaking pathology of disease while handling patient with love and affection.
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Bad prognosis

Prakrutistheshu bhuteshu upekshanam –

If disease is incurable or if patient is in a condition where any form of treatment would not help in making him healthy or keeping him alive, physician should avoid treating such conditions.

A good doctor is one who knows when to treat a disease, when to refuse and when to refer. When he knows his limitations he can do best service in medical field. For this, he should have thorough knowledge of all factors related to disease mentioned in previous criteria. Apart from this, he should also have knowledge of signs and symptoms of bad prognosis of a disease i. e. Arishta lakshanas.

This will not only help him to refuse patient but also to see if there is any other option of saving patient’s life by referring to specialists, in time, without wasting patient’s time. This is more in sync with today’s medical practice because when referred at proper time, sophisticated facilities available in medical system will help in saving and resuscitating life of patient. In olden days Arishta lakshanas were criteria for rejecting patient and a disease because those were signs which were used to calculate lifespan (remaining or residual lifespan) of patient and bad prognosis of a disease, which was at a point of no return, which indicated that death is inevitable.
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Rejection of patients in grave situations where death is certain – helps doctor to save his name, fame and respect. With lot of doctors being attacked for accidental medical failures, it is wise for a physician to play safe.