A Visit To The Doctor
On a Lighter Note: Of Medicine, Memory, and Manners
Now we know how pharmacies work, and the pill-aversion habits of most, we must visit the local doctor.
The local healthcare system is quite simple, really.
First, there are loads of private clinics — doctors who return from their hospital jobs, and run a clinic in their home, or at a leased premise nearby, but more often than not, at home.
Work from home was always a thing!
Evenings 5pm-9pm.
Lines form.
No appointments were needed. It was first come, first served.
You arrive, hopefully earlier than the doctor from his inner sanctum, and engage the local attendant — known simply as the ‘compounder’ in a nod to our British association, the earliest known usage of which can be traced to 1539.
Depending on his mood, and how pleasant you are to him, he may place you higher than the others if it serves his need. Or if you spoke to the doctor directly, and he offered you a 7pm appointment, then you can be hopeful of an earlier entry.
This of course requires you to catch the compounder’s eye at regular intervals, especially when one patient exits the doctor’s room.
If it is a busy evening, he will studiously avoid your eyes, for he has no answer yet. You wait patiently.
Now, of course, you can book appointments with most online or by WhatsApp or phone.
Still, you may have to wait and make a fuss to ensure they don’t forget about your ‘time’ when you arrive.
As you will soon discover, the greater the doctor’s reputation, the larger the crowds.
What is this you say? The rich getting easy access. What about the poor?
Fear not, everyone gets an equitable chance at a doctor with varying qualifications.
One may have just graduated from a government-run medical college, and received an MBBS1 (the first step in the ladder).
The first order graduates mostly serve rural clinics and primary health care centres in urban neighborhoods.
From there on, it is the MD, and MD from a premier institute, or best of all, the coveted qualifications from overseas institutions.
Why doctors return is a mystery, but they do — some to serve, some to be comfortable.
FRCS (UK), US medical schools, Singapore, Australia, Germany. A physiotherapist from Scotland University.
It serves as a filter to credential the doctor. In a world of doctors, it is as simple as that.
Just an MBBS won’t cut it. Not for the middle and upper classes.
Even the workers with a steady income know this — if you can afford it for your loved one, and the issue is severe, try to go to a private clinic or hospital that has affordable consulting rates rather than the free clinics.
Large hospitals also offer pro bono and discounted medical services, but that story of the industry will have to wait.
But the government doctors do their best.
With sometimes inadequate infrastructure, and a larger density of populace to be covered, they still pay homage to their Hippocratic oath.
Funny that, a Greek doctor, whose words form the oath of a modern Indian doctor.
The circle of humanity is untethered to national origins.
Consulting fees for the private doctor: Rs. 500 ($6), a hefty sum for some, and affordable for others.
Never pay the doctor directly, that’s still a No-no.
In the doctor’s room, it is about healing.
Outside, with the attendant, it’s about payment.
Sometimes, you may ask the doctor what is to be paid, and a little discomfited, he will either share his amount, or suggest you talk to the attendant outside.
Doctors don’t like to be associated with the commerce, just the healing.
If the doctor is associated with a large private hospital, it may rise to Rs. 1000 ($12) and you are allowed a free follow-up within 3 days. Else, you shell out another $12. Seniors get a 5-10% discount.
Systems are in place to take care of this - pay first, then see the doctor.
There were old-school clinics, run a while back, pre-modern India, when the compounder also prepared your medicine — the doctor had his own concoction for fevers, flus and colds.
Wooden tables, chairs. White walls. A window in the wall to receive your medicine.
It could be pills methodically folded by dose in long, narrow strips of white paper, sometimes marked in pen on the outside. Open 'em like a treat, and good health is the reward.
Or.
A transparent glass bottle marked by a white label with black portion lines.2
Reddish pink in color.
Looked like candy water.
Tasted a bit sweet and bitter.
A spoon you got per the doctor’s instructions — whether it was real or placebo, you got better in no time.
Unreal?
More such true stories abound.
One expert held a hand, and by the pulse — nadi, in Sanskrit — detected the uneven heartbeats of a child and suggested surgery was needed.
Another, a first order doctor, at a school health check-up, found a special issue that needed follow-up and likely saved the child.
What did I say about ancient cultures and traditional ways?
They work through doctors as well.
Didn’t this ancient land have rishi3 doctors too?
Perhaps their knowledge has been inherited — or perhaps, forgotten.
Older adults will attest to this phenomenon of country doctors — like Star Trek’s McCoy — knowing best.
Mourning the loss of that knowledge when they come across hospitals asking doctors to meet quotas.
For, as a kid, they remember, if you scraped your arm in school, their grandmother would take them to the nearby hospital — medium-sized — not too fancy — and the resident doctors, under tutelage of senior doctors, would make you laugh and distract you while they scraped the dirt off your skin, and you forgot to wince.
Grandma, of course, did her duty by her favorite grandchildren, and no one at the hospital minded that she was the one who brought you to the hospital while the kid’s parents were busy minding the house and the other children.
In India, everything goes — so much so that there is even a local saying for it in Hindi — ‘chalta hai’ — it goes!
Except when a woman is being seen by a male doctor — then a female nurse always stays in the room during the examination. Manners must be minded.
So it goes.
Clinics are in every neighborhood with doctors of varying levels of expertise.
Run by a doctor couple sometimes — both in internal medicine, or different specialties.
Sometimes, one is better than the other.
But you know that ;-) Couples can be different.
Clinics — always crowded in the evenings.
During the day, the doctor may receive a salary from working for the larger hospital.
When medical students graduate from government colleges, they must do a rural stint or an urban free clinic stint — after all, their education was paid for nominally by them and mostly by the government.
Catering to the poorest sections — many doctors choose to work so.
So, when I wrote earlier, a doctor’s experience matters — it shows.
Millions of patients give weight to a doctor’s prescription — they know when meds work, and when they don’t.
The doctor, seeing the patient’s economic status, limits what tests she writes, and makes do with her experience to offer the next best medicine she can.
When she absolutely must, she prescribes tests.
Conscious — whether poor or middle class — that no one wants to be paying undue amounts for a doctor’s visit.
What of the poor? Beyond government clinics, what options do they have?
Many pharmacies hire doctors, and offer free clinics, or services at nominal prices. Some even have mini-hospitals.
Charitable trusts run clinics.
Primary healthcare centers are run by the government.
In private practices, and hospitals, you can book an online appointment with a doctor of choice, or virtual video consult, or show up in person.
Colds, coughs, flus, minor or major ailments.
Wait an hour or less, get seen, get the meds filled at the hospital pharmacy or outside, at your trusted neighborhood pharmacy.
Did I mention they deliver?
You WhatsApp them the prescription, and voila, it arrives within minutes or an hour depending on your arrangement.
What if you are faced with a situation where you cannot take the patient to the doctor?
Well, the doctor comes home. In many places, they still do.
For in India, it is true — the mountain does come to one.
The concerned loved one brings him, or her.
Extra fees — but not always.
Doctors, in India, you see, are equated with God.
Or for the poor, God and their parents — the sole refuge.
Who else can cure illness, and restore life to an ill child and make her laugh again?
For whether rich or poor, the child’s laughter is precious. Or the continued blessings of the elderly.
They will honor any person who restores it to them.
So, the doctors and nurses enjoy an exalted status within the culture.
Especially the ones who serve.
MBBS = Bachelor of Medicine, Bachelor of Surgery.
A friend reminded me that both the pills wrapped in paper, and similar bottled syrups known as ARAQ are traditions handed down through generations.
Sanksrit. Rishi = Sage.
Thank you all for the thoughtful comments and encouragement on this post!
I’ve lightly updated the piece — adding a few more glimpses into how clinics and doctors work in everyday life, and touching on the culturally unique features around payments. Thanks for reading, Jayshree
Loved your article Jayshree. I travelled all over India in the early seventies, worked at an Indian university in South Africa for 7 years. and your article reminded me of the empathy I experienced at a visit to a doctor. The reference to "The Compounder" is so interesting from a historical point of view, its precious.