Medical ethics

How a child suffering from Kala Azar in rural Bangladesh went on to become a renowned oncologist

Dr Fazlur Rahman, who has authored a book on his journey, speaks to '' about the importance of empathy in medical sciences.

In this book, The Temple Road: A Doctor’s Journey, Dr Fazlur Rahman talks of his life story – from a boy born to in rural East Bengal (now Bangladesh) to a leading oncologist in the US.

Growing up as a childhood in a small village in Pora Bari, he experienced at first hand the vulnerability of a person suffering from a potentially fatal disease. As a child, Rahman had Kala Azar, a parasitic illness spread by sand flies that causes a greyish discolouration to the skin, bouts of fever and enlargement of the spleen, among other symptoms, whihc almost killed him.

But he managed to beat it, going on to study in the Dhaka Medical College, the biggest medical college in Bangladesh and later win a scholarship to St John’s Hospital in New York. After becoming a US citizen, he wrote essays on medical ethics and other social issues related to medicine.

In an interview to Dr Rahman talks about how his childhood shaped not just his personality but also his practice and the need for doctors to be empathetic.

How your childhood in Bangladesh has shaped the way you practice? You fell sick when you were child, lot of premature deaths, no medical facilities. How something like that impacts the way you work as a doctor
In the book you have read, my mother died when I was only seven. A child remembers some things more than the others. She had a brother who was very dear to her. He died also of malaria. She said someday you will be a doctor, Fazlur. Then she also died suddenly, that thing is stuck in my mind. If she had lived for a long time, perhaps I would have forgotten that.

After she died, and when I was recovering from the grief and sadness, I developed Kala Azar. it is a parasitic illness. It almost killed me. When you become a doctor, you get a sense – I have been through that. When I see a person who is a patient, I have some understanding about their difficulties.

I am not saying I am any better or worse than any other doctor. But because of my upbringing and because of life experiences, I have developed some sensibilities [that help me understand these patients]. Can I practice [it] every single day every single hour? I am sure sometimes I fail. But I try to understand the patient and their suffering – show empathy.

You write about your training in Dhaka Medical College where your teachers, emphasised the importance of speaking to the patient and taking their history. This practice, one could say, has taken a setback. Now doctors stress more on getting tests done.
We have to accept change. Technology is an important part of medicine. But my concern is that simply having MRI or CAT scan or PET scan alone [is not enough]. You still have to talk to the patient. You cannot replace bed-side understanding of the profession. I am not the only one, many other doctors talk about this, here in India too.

We are getting more impersonal because of technology. It is not the fault of technology. It is simply because we rely on it too much. In the past we did history and physical [examination] because we did not have as much technology. Now, if someone complains of chest discomfort, it is easy to order a CAT scan rather than checking a person thoroughly. It is expensive too. We have to use technology, but with restraint and when we need it. Not indiscriminately. Simply because it’s available, you should not use it very quickly. Bedside medicine is still important despite technology. That is my point.

What is the importance of compassion in medicine? Do we need to take another look at how students are trained in medicine?
I teach humanities and medical ethics in the Angelo State University, Texas. I start with empathy and compassion. My own feeling after practicing all these years is that you cannot study empathy.

We have too much emphasis on science (in medical schools). We need science to be a doctor. But you also have to understand empathy, compassion, and human rights. If you get a patient with lung cancer, he is not just a lung cancer patient. The same patient may have other problems. He has a family and children who are suffering too. As a doctor, we have responsibility to understand the patient and show sympathy. We need technology, but we are becoming a little more impersonal. When patients feel like they don’t care, they get upset and angry.

In India, there are often reports of resident doctors getting beaten up, many times by relatives of patients. Could this be because of lack of communication?
We do not have that (in the US). We do not know that. That’s part of the communication problem. We have a tendency to not give bad news. If a patient has lung cancer, we need to tell his relatives – sir, your father has lung cancer, he may not get better. He may not get cured.” If you do not explain anything, they will feel – what have you done?

Medicine has become business and you mentioned that you were uncomfortable taking fees.
Yes, I didn’t know about business side of it. But I do feel that when medical students are trained, they need to know about business side.They don’t have to be a MBA, but they need to understand that when they order a CAT scan, it costs thousands of rupees. When you drain the patient’s resources without explaining to them what the purpose is, and then the patient dies, the relatives do not feel good about it. Residents need to think twice before ordering a CAT scan.

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