A healer must have a large heart coupled with a strong and well-trained head
Richard Smith, a former editor of the British Medical Journal, once wrote in an editorial about the poor communication skills of doctors in general and their incapacity to deal with the uncertainties in medicine. Doctors have been attempting to predict unforeseeable outcomes of their interventions. This oracular tendency among doctors is at the root of patients’ loss of confidence in doctors. If one is well and healthy at any given time, it is because of chance; on the contrary, if one is unwell, it is again because of chance.
The solution lies in training medical students to accept that doctors are fallible like anyone else and can make mistakes. Being honest about mishaps and sharing one’s joys and sorrows with the patient could ease the situation and enhance communication. The crux of the healing process is the coming together of two human beings: one who thinks he/she is ill and the other in whom the former has confidence. This coming together of two human beings, with mutual trust, is the summit of medicine from where all other aspects like diagnosis, therapy, future management, etc, follow. It is here that the patient gains confidence in his/her doctor.
In the past half century, technology has deified the medical profession, leading patients to expect the moon from their doctors. One of the reasons for the burgeoning consumer suits against doctors and hospitals in the West is precisely this. The holy doctor-patient relationship has become that of a seller and a buyer, resulting in market forces uprooting medical ethics. “Cure rarely, comfort mostly, but console always” was good Hippocratic advice. It is not what the doctor tells the patient that counts but what the doctor does that impresses the patient. Once the patient realises that his doctor does walk his talk, patient confidence is easily won.
William Osler said that a doctor needs two great qualities—imperturbability and aequanimitas. If the doctor can communicate well, diagnosis becomes a pleasure at the bedside. “If you listen to your patient long enough, he/she will tell you what is wrong with him/her,” wrote Lord Platt in 1949.
Confidence is built by the doctor’s ability to listen to the patient. Listening is a difficult art. Every medical student should be trained to master the art of listening. Henry David Thoreau wrote, “To affect the quality of the day—that is the highest of arts.” The art of listening to the patient is the capacity of the doctor to enhance the quality of the patient’s day.
Listening to the patient is not confined to listing the patient’s symptoms, past history, his social and family history. The crux of the art of listening is to understand a patient’s fears, his religious, spiritual and social beliefs, his cultural upbringing and, more than all that, even his irrational obsessions in terminal illnesses. Even if the doctor is a rationalist and thinks that medicine is a pure science, he/she will have to try and understand the irrationality of the patient’s thinking to respond to the patient satisfactorily.
Healing is universally possible while curing is rarely an attainable goal in medicine. A healer must have a large heart coupled with a strong and well-trained head. Combining humility and wisdom is not impossible, but it is difficult. A book that I’d recommend to doctors is On Doctoring by Richard Reynolds and John Stone (Simon and Schuster, New York).
My personal experience, since I first started seeing patients in 1956 as a medical student, has been that if I have a genuine interest in the patient’s welfare, the patient would have full faith in me. This matters a lot in the final outcome of illness, uncertainty notwithstanding. Faith heals.
(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS.)
Jindal Steel and Power is already facing CBI probe for alleged cheating and misrepresentation of facts in bagging the Amarkonda Murgadangal block in Birbhum district of Jharkhand in 2008
Jindal Steel and Power Ltd shares fell by over 13% in early trade Monday on the BSE and National Stock Exchange (NSE), following news reports about the Central Bureau of Investigation (CBI) filing fresh case against the company.
The Investigating agency, which is probing into coal blocks allocated during 1993-2005 period, filed a fresh case of alleged cheating and corruption against the company.
Following this, the company’s scrip fell 13.57% to Rs128 — its 52-week low on the BSE. On the NSE, it slumped 13.51% to hit a one-year low of Rs127.70. The scrip was the top loser among 50-Nifty scrips.
Later, the stock pared some of the losses and at 3.29pm was trading at Rs136, down 8%, on the BSE.
According to a CBI spokesperson, it is the 36th first information report (FIR) filed by the agency in connection with its probe in the coal allocation scam.
The fresh case has been registered against Jindal Strips Ltd (now known as Jindal Steel and Power Ltd) and unknown public officials for alleged criminal conspiracy, cheating under the Indian Penal Code and Provisions of the Prevention of Corruption Act, CBI said.
Soon after registering the case, the agency on Sunday carried out searches at four locations in Raigarh in Chhattisgarh.
CBI sources said the case pertains to allocation of Gare Palma IV/1 coal block to Jindal Strips Ltd and JSPL.
The company spokesperson had said JSPL reiterates that all its actions are in keeping with the legal framework of the country and that it complies with the law in letter and in spirit.
“JSPL continues to cooperate with all the authorities in a responsive manner,” the spokesperson had said.
The company is already facing CBI probe for alleged cheating and misrepresentation of facts in bagging the Amarkonda Murgadangal block in Birbhum district of Jharkhand in 2008.
Baker Mitchell is a politically connected North Carolina businessman who celebrates the power of the free market. Every year, millions of public education dollars flow through Mitchell’s chain of four nonprofit charter schools to for-profit companies he controls
In late February, the North Carolina chapter of the Americans for Prosperity Foundation — a group co-founded by the libertarian billionaire Koch brothers — embarked on what it billed as a statewide tour of charter schools, a cornerstone of the group's education agenda. The first — and it turns out, only — stop was Douglass Academy, a new charter school in downtown Wilmington.
Douglass Academy was an unusual choice. A few weeks before, the school had been warned by the state about low enrollment. It had just 35 students, roughly half the state's minimum. And a month earlier, a local newspaper had reported that federal regulators were investigating the school's operations.
But the school has other attributes that may have appealed to the Koch group. The school's founder, a politically active North Carolina businessman named Baker Mitchell, shares the Kochs' free-market ideals. His model for success embraces decreased government regulation, increased privatization and, if all goes well, healthy corporate profits.
In that regard, Mitchell, 74, appears to be thriving. Every year, millions of public education dollars flow through Mitchell's chain of four nonprofit charter schools to for-profit companies he controls.
The schools buy or lease nearly everything from companies owned by Mitchell. Their desks. Their computers. The training they provide to teachers. Most of the land and buildings. Unlike with traditional school districts, at Mitchell's charter schools there's no competitive bidding. No evidence of haggling over rent or contracts.
The schools have all hired the same for-profit management company to run their day-to-day operations. The company, Roger Bacon Academy, is owned by Mitchell. It functions as the schools' administrative arm, taking the lead in hiring and firing school staff. It handles most of the bookkeeping. The treasurer of the nonprofit that controls the four schools is also the chief financial officer of Mitchell's management company. The two organizations even share a bank account.
Mitchell's management company was chosen by the schools' nonprofit board, which Mitchell was on at the time — an arrangement that is illegal in many other states.
Charters are privately run but government-funded schools that are supposed to be open to all. Policymakers and many parents have embraced charters as an alternative to poorly performing and underfunded traditional public schools. As charters have grown in popularity, an industry of management companies like Mitchell's has sprung up to assist them.
Many of these companies are becoming political players in their states, working to shape the still-emerging set of rules charters must play by. A few, including Mitchell's company, have aligned themselves with influential conservative groups, such as Americans for Prosperity and the Koch-supported American Legislative Exchange Council, or ALEC.
This new reality — in which businesses can run chains of public schools — has spurred questions about the role of profit in public education and whether more safeguards are needed to prevent corruption. The U.S. Department of Education has declared the relationships between charter schools and their management companies, both for-profit and nonprofit, a "current and emerging risk" for misuse of federal dollars. It is conducting a wide-ranging look at such relationships. In the last year alone, the FBI sent out subpoenas as part of an investigation into a Connecticut-based charter-management company and raided schools that are part of a New Mexico chain and a large network of charter schools spanning Illinois, Indiana and Ohio.
Two of Mitchell's former employees told ProPublica they have been interviewed by federal investigators. Mitchell says he does not know if his schools are part of any inquiry and has not been contacted by any investigators.
To Mitchell, his schools are simply an example of the triumph of the free market. "People here think it's unholy if you make a profit" from schools, he said in July, while attending a country-club luncheon to celebrate the legacy of free-market sage Milton Friedman.
It's impossible to know how much Mitchell is taking home in profits from his companies. He's fought to keep most of the financial details secret. Still, audited financial statements show that over six years, companies owned by Mitchell took in close to $20 million in revenue from his first two schools. Those records go through the middle of 2013. Mitchell has since opened two more schools.
Many in the charter-school industry say that charter schools are more accountable than traditional public schools because, as Mitchell is fond of saying, "parents can shut us down overnight. They stop bringing their kids here? We don't get any money."
Moreover, Mitchell said, students at his two more established schools have produced higher test scores at lower costs than those in traditional public schools: "Maybe Baker Mitchell gets a huge profit. Maybe he doesn't get any profit. Who cares?"