When we entered medical school in the 1970’s we were full of hope and optimism believing that once we graduate we will prescribe a pill for every ill to eliminate human suffering. Our dean was a very learned and wise professor of Medicine. He was also a Second World War veteran. No one can forget the introductory lecture he gave us. It was humbling.
He asked the class whether any one of us owns a car in the house, uncommon those days. Only one girl raised her hand. He asked her to imagine what would be her options if she is passing through a village and the car breaks down. There is no car mechanic in the village, only a cycle repair man. She hesitantly answered she would seek help from the cycle repair man. The dean informed us that after we become doctors we would be like a cycle repair man trying to fix a car. By some luck a cycle repair man may fix the obvious problem like a loose wire or a flat tyre while he may be clueless about any major problem in the engine. He taught us humility before nature which confers immense self healing powers if we obey its laws.
Miyamoto Musashi, the ancient Japanese swordsman and Samurai of the sixteenth century refined the art of the two sword technique, the long and the short sword. He stressed the correct choice of the swords according to combat situations.
Similarly, in the healing art we should first use simple history taking, clinical examination and inexpensive time tested remedies including lifestyle changes all symbolizing the “short sword,” to enhance nature’s healing powers, before resorting to costly investigations and use of state of art technology which can be compared to the “long sword.”
It is natural for young doctors passing out of medical schools to be fascinated by the glitter of the long sword—the latest and costliest medical technology and drugs. No doubt, the miracles of modern medicine particularly in the surgical fields are noteworthy. But while the mechanical approach may be appropriate in surgery, for instance, fixing a broken bone, or changing an opaque lens in the eye—these are like fixing the external dents or headlight in the exteriors of a car whereas fixing the interior engine which drives chronic diseases is more challenging. Nature still has an upper hand in these and it is only recently that modern science is discovering the interconnectedness of the various systems for instance the gut-immune connection and gut-brain connection and the major role played by gut microbiome in both. It is fascinating to note that most of the traditional systems of medicine including Ayurveda have this holistic approach to health and disease. Hopefully, the parallel lines of different systems of medicine may meet in the future.
Ayurveda’s rootedness in Indian philosophy is responsible for its emphasis on the central role of nature in healing. For a physician to realize the importance of the art of healing, a liberal education in literature, philosophy, and history of medicine would be of great help. A few Western schools of medicine have already started courses in these subjects for medical students.
Faroukh Udwadia, a senior physician once memorably said, “A study of the humanities gives you a wider perspective. After all, we exist in the world; the environment interacts with us, isn’t it? And if you want to know exactly how a human being works, you will be much better off if you had a good idea of the humanities. Read poetry, literature, and you get a good idea of what suffering is. If you can appreciate your patient’s suffering, your response to his disease is much better. As for history doctors should at least know that of their own profession. All of us stand on the shoulders of discoveries of past greats, who had no access to the modern technology that has swept over us today. This also gives us another essential quality, humility.”
For the majority of human illnesses, the short sword wielded skillfully practicing the art of medicine is sufficient without need for costly interventions, the long sword, which has the potential to harm howsoever remote. Using the short sword also cements the doctor-patient relationship which plays a strong part in recovery.
The consummate doctor, who knows the correct use of the long and short swords, is rare nowadays. Indiscriminately, long swords are being used, which is becoming longer, unwieldy and costly with technological advancement. Powerful weapons should be cautiously used to prevent collateral harm. Presently, iatrogenic diseases (those cause by medicines and interventions) are one of the leading causes of deaths and disability.
Unfortunately, during the war against the enemy in the battlefield, as well as in war against diseases in health care, the long sword is being used increasingly. The “art of war” gave way to the “science of war” escalating to chemical, biological, and nuclear warfare. Combat became blunt and artless with more and more collateral harm to civilians and innocents. The nuclear bombing of Hiroshima and Nagasaki which ended the Second World War bears testimony to the catastrophe when the long sword grows unchecked becoming a sword of Damocles hanging over humankind threatening its extinction. Powerful invisible forces have usurped the autonomy of individual soldiers. He no longer can decide which sword to choose. Commercial interests, politics, and arms race has killed the art of war.
The field of medicine is facing similar dilemma. Unchecked growth of the long sword has killed the art and fragmented the science of medicine. From a calling medicine has become a business and big business. Like the soldier, the doctor too has lost the autonomy. Commercial interests, political influences, and pharmaceutical companies are responsible for this. A young doctor cannot survive outside the corporate model. Once in this system he has no choice but to go along with the long sword of costly investigations and treatments. Both the soldier and the doctor have lost the autonomy of choosing their weapons and tool-kits.
The world is facing a double threat from the arms race and the pharma race. Wise doctors from all systems of medicine need to come together to work with humility toward restoring the art of medicine and making whole the fragmented science. Newer researches have the potential toward holistic medicine combining the best in all systems and discarding the worst, while using newer technologies judiciously and not blindly. Healers from all systems of medicine should have humility to acknowledge that for a long time to come all of us are like cycle mechanics trying to fix a car. In our arrogance, if we presume that we can sit on nature’s throne we must remember the “sword hanging over Damocles” implying that with great powers comes great responsibility as well as risk.
Lastly, in this era of fast technology, in addition to the Hippocratic Oath, “The Physician’s Prayer” composed by Sir Robert Hutchison should be known to all doctors.
From inability to let well alone, from too much zeal for the new and contempt for what is old, from putting knowledge before wisdom, science before art and cleverness before common sense, from treating patients as cases and from making the cure of the disease more grievous than the endurance of the same, good Lord deliver us.
1. Musashi M. The book of five rings - The strategy of the samurai. New Delhi. General Press 2019.
2. Wu HJ, Wu E. The role of gut microbiota in immune homeostasis and autoimmunity. Gut Microbes 2012;3:4–14. doi:10.4161/gmic. 19320.
3. Clapp M, Aurora N, Herrera L, Bhatia M, Wilen E, Wakefield S. Gut microbiota's effect on mental health:The gut-brain axis. Clin Pract 2017;7:987. doi:10.4081/cp. 2017.987.
4. Fung TC, Olson CA, Hsiao EY. Interactions between the microbiota, immune and nervous systems in health and disease. Nat Neurosci 2017;20:145–55. doi:10.1038/nn. 4476.
5. Wallace RK. The microbiome in health and disease from the perspective of modern medicine and ayurveda. Medicina (Kaunas) 2020;56:462. doi:10.3390/medicina56090462.
6. Banerjee A. Empathy in the time of artificial intelligence:Fiction not fact may hold the key. Med J DY Patil Univ 2020;13:97–9.
7. Karkaria B. Dr Farokh E Udwadia: Medicine is learnt more at the bedside than from books. Mumbai Mirror, Jan 28, 2018. Available at: https://mumbaimirror.indiatimes.com/others/sunday-read/dr-farokh-e-udwadia-medicine-is-learnt-more-at-the-bedside-than-from-books/articleshow/62676135.cms
8. Panagioti M, Khan K, Keers RN, Abuzour A, Phipps D, Kontopantelis E, et al. Prevalence, severity, and nature of preventable patient harm across medical care settings:Systematic review and meta-analysis. BMJ 2019;366:l4185. doi:10.1136/bmj.l4185.
9. Bunni J. Complications - A surgeon's perspective and humanities'methods for personally dealing with them:The “4 R's”. Int J Surg 2017;41:134–5. https://doi.org/10.1016/j.ijsu. 2017.03.076.
10. Huthison R. The physician's prayer. BMJ 1998;317:1687.