Surgery is scientific, unfolding if regions of body, gutted with disease, ending in it removal or repair to give ……….. result for a healthy living.
It is a passion with glamour which attract youth. Young student glamour for high profile jobs with unprecondted payments in early life, but a group in it his there own vision, motivated by family profession or Surgeons in society working with dedication. Surgery has its own message of happiness and smile after fulfillment of procedure and back to normal life. All this give a positive wave and attract young students ignoring many attractive professions as of now with high perks. These young students have passion to achieve some dreams seeing for years in past and trying hard. It is hard to get admission in a medical institution and once get in has to work more hard to complete course based on some old pattern since its inception. First this disguise that but get adjusted to adopt to the system. Here many get disillusioned and passion is take over by reality and change in attitude. The surgical field had always been changing, controversial some time, attracted best of brains, to change its out work from pain to painless and big to small incision and recovery or shortest time. But human behaviours and surgeons attitude has some how basically same except the social, religious, political and economical changes in time period frame.
Historical Aspects
As we go back in the history of medicine, 5000 AC, or later it was Human constant endeavour to suffering, laid to the anxious ……… To study human body and found its cause and remedy. Survival was difficult and war is different types, resulted in War weapons and same used with some changes in management if war injuries. As civilization progressed from Medical period to Renaissance and further cutting weapon to cutting instruments, further dynamite to its medical use, to modern radio imaging laser and robots are the product out of war to help humanity.
As far history is known of Medicine in prehistoric era, from regimen of medicine were followed namely Greek, Islamic, Ayurveda and Chinese… Hipporates (450 BC) Father of Medicine, a Greek Physician analysed the human body and its various aspect with connection laid down basic principles of medical practice known as HIPPOCRATIC OATH as followed in patient era. He believed that nature heals all wounds and Physician is a modifier to the natural process.
Albucasis (Abdul Qasim Al. Lahrani) (936-1013) designed many instruments and defined many surgical procedures.
- Trepasining (hole in head) on head injury was known in Mesolithic age (10,000- 6000 B.C.)
- Blood letting, tooth Extraction were performed by mostly Clergy Man, Religious Masters, and Kengi Man and Known as Barber surgeons. These procedures were crude and painful. Many concoctions of juices, and extraction used to let patient go to sleep were used even causing death. Hemlock Juice was such a concoction of lettuce juice, gall from a castrated boar heredry, opium, heisbane, vinegar mixed with wine and given to patient to drunk before surgery in early part of A.D. This was stat of anesthesia, to give painless surgery. Paracalsus used ETHER first and later chloroform was invented. Can….. the bleeding wound (1500-1000 BC) and bandages to cover wounds : followed by ligature control of wound popularized by French Surgeon – Ambriose Pare.
India had been a centre of medical education and treatment even in 5th century B.C. Sushruta – father of Indian Surgery and Atreay (600 B.C.) were pioneer in many operative procedure, cleanliness, and postoperative case as defined in Sushruta Samhita (6 volume) Lord Dhanvantri “Patron Saint of Surgery” taught medicine to his disciples, Daksha Prajapati’s and transcended descended to many Rishis to serve people. SAMHITA period (800-700 B.C.) era was a period of scientific and rational medicine as seen in Yajurveda. Takshila and Nalanda (500 B.C.) were centre of excellence even in medical care and teaching attracting persons from all over the world.
Development from Renaissance period to the present century had been gradual with success but with cruelty. Search for painless procedure and training to people to perform their duties was dominant in the minds of Rulers and Clergy Man. In 1215 Pope ordered to Monks to stop Surgery and prevented Barku Surgeons. Churches promoted centres in Europe where people used to get training in more systematic way to give relief to the patients.
In 16th and 17th century along with development of Educational institution, centre for medical care started coming up in Europe and America. In America hospital started in New York (1708- collapsed due to war and 1804) Cambridge (1783) Boston (1783) Columbus (1767) Pennsylvania (1769) and Harward (1783). In Europe, London Edinburgh, Paris, Rome and Vienna, were the centres in 16th and 17th centuries where people from America and other countries came for learning and developed centres in their countries.
Modern Medicine started gradually but in big way in early part of 18th century with ETHER, Chloroform for anesthesia, germ theory of Liser (1861).
In Itly city of Salerno, was influenced by Greek part and produced many male and female medical practioner and medical knowledge was written down and known as ‘REGIMEN OF THE SCHOOL OF SALERNO” for the King of England. Aristotle’s view of nature of Physics and medicine, eventually called as “PHYSICA”, and the word PHYSICIAN was developed.
History gives us a lesson of competitiveness, desire to excel, outer forces pressures to compromise, state interference, jealousy, lating down our own colleagues, high social status majority in comfortable financial zone but average in financial social status, but a person if integrity, devotion, commitment and dependable. In which profession a person gives his/her body to work on with full confidence and respect next to GOD. It is true We treat and He cures, but credit is high with gratitude. But the same gets lost in case of even unavoidable complication and surgeon become devil. A part of Professional hazard but its cause and cure somehow his with us only. Unbelievable, but truth, even in prehistorical periods this as well in early modern period also – Surgeons were revenged and punished for no fault. Surgeons have to learn beside surgical skill, to be skillful in communication and public dealing.
Surgical teaching and practice in India is still based on English pattern of pre independent era, with minor changes without changing the basic structure. USA has completely changed subjects, its matter, duration and techniques as per the demand of time and facilitated training as per requirements, proficient skill feel training to benefit surgical care, and upgraded hospitals as per emerging development UK and Europe has these own system but changed with the time. India has anomaly of Government run institution including Medical College Hospitals with minimum facilities and upcoming corporate Hospitals as good as anywhere in the world to line medical tourism. This country is a place of contrast with high number of millionaire and high economy as well way low in poverty line. Public is happy and contended with the system. Basic treatment to all should be the National Scheme and Private-Public Partnership in Medical highway in the demand of the time.
Surgeon after graduation and getting Master degree is on his own to learn to become skillful. He is on his own and passage of time learn and earn to give benefit to the society. No graded system in the country to living best out of them to give better services and satisfaction to Surgeons. Public wants 100%. Is it possible anywhere in the world? But our efforts should be genuine and true in terms of surgical skill, pre operative care, operation theatre management and post operative care to deal with all eventualities, to give early recovery. WHO – charter of World alliance of Patient safety needs to be implemented at all level of Hospitals.
In developing Countries, major part of Surg4eons are General Surgeons and competent to deal with all types of Surgeon in most of the specialities. 70 years back General Surgeons used to do orthopedic, ENT, Gynae and Eye Surgery but now with them as other specialitis, Scope of General Surgery is widened to include sub specialities of GI, Vascular, pediatric, Cardio Thoracic etc. Basic Surgical problems in all these specialiteis are delt by General Surgeon skillfully in majority of the hospitals. Besides developing those specialities, country cannot produces specialist to deal above specialities even in all cities. Needs is to train General Surgeon giving short term training and guide them time to time. More then million patients die of surgical complications, which are preventable. Sincere efforts to such programmes, supported by Govt. of India and all Surgical Association (P.P.P. Model) will boost surgical care and health of the country. Minimal invasive surgery is the demand of time. Good centre for training, support of corporate hospitals and media, and high hopes in public has lived young, surgeon towards its. It has a long learning cure but has limitation also. Beside technical aspect many other factor need attention like time spent in hospital and its financial aspects, limitation, dealing the complication, and above all Surgeons ability to say NO if not proficient in any particular procedure.
Responsibilities of Association
Members of Surgical Oriented Association may be Association of Surgeons of India (ASI), Indian Association of Orthopedics, Indian Association of Obst and Gynecology and many others, represent Surgeons in there specialities comprising thousand in each section and may be more than 2 lac over all. But more than their number are not the members of these Association. Large Surgeons are in field without any guidance, field for improvement and complication to update knowledge. Surgeons should unitedly form a policy with the help of Politician and Government to enroll every Surgeon and Physician to be a member of its association beside registration in the Medical Council and Chart out a time bound CME’s and training programme to update then and follow results to improve patient care and Safety to Surgeons from unnecessary litigations. American Surgical Association can be a model to start with, and changes, amendment as per our need, will be a step further to salvage our prestige and enhance ourselves for better productivity to grow in our own eyes.
Are our training programmes helping the total system in the Country? A basic question to be answered by all those at the helm of controlling such programmes. Demand of Surgeon in Metropolitan cities, tier II, III and rural areas are different. CME’s programmes at State, and district levels are dealing with same problems and do not guide to them as per diseases and challenging problems of management in those areas. Let us define the areas and those problems subject wise and solve it scientifically by Surgeons working hard for it and not be professional surgeon speaking on any subject without understanding the expectations of the audience.
Commercialization
India is shinning and economy is going high and leading in many fronts including industrialization, agriculture farming, pharmaceuticals and reaching to the top 5 economics in the world. Health Care is not a priority by Government and spending 1.02% of its fiscal income. Corporate Hospitals and Group Hospitals are coming up in large numbers spending million in this sector to give better medical care and earn money. Accepted formula but under affordable limits considering many levels of living standard form High to Poverty line. Here also basis concept of P.P.P. Model and Cooperative institutions using high tech equipments from our own technology and similar group of other countries will reduce the cost. Stress should be on equipments and hospital management rather on sophisticated buildings. Thus needs Indian System of developing in different pattern of building suitable to our environment and patients comfort.
Surgeons responsibilities become high in favour of patient and patients care. Commercial deals and attitude needs change with clear financial policy in the hospitals and clinics to be transparent to gain patient confidence. Proper communication and correct surgical advise, increases patient and there relation mar…… and confidence to fight disease and healthy relationship. It reduces many problems including litigations.
Surgery is salvaging from untoward body agony to give relief and restor body tissue anatomically. It is a science to know body and its function and to bring it back to normal with his skill and hard work. As you grow, skill becomes more sharp but hand become more smooth and make it an art of perfection, where Surgeons enjoy at the cost of Patients smile Surgeon enters its temple of operation theatre with serene mind and get lost in meditation while doing procedure for hours, and comes out with satisfaction and energetic. This worship to your profession and devotion towards your patient. This is passion with proficiency, leaving profession at its back. Being professional, he is involved in its system but different from others, as moto is to serve first and then expect what he deserves.
A Doctor is a professional person any envy to others for his social status and earning without realisation of his hard work, family compromises, personal negligence and outside pressure. Changes of time do change professionalism and its definition and Doctor cannot be left from it. He is also influenced by outgoing commercial factors, sometimes, deforming profession. It has to be taken in proper perspective and continue work without prejudices. Surgery is a piece of poem with shape of a sculpture and music of life to impart solace to one who need it. Be a part of this holy profession and be proved of it.
