Physicians may once again have the ear of their communities. To sustain this regained trust, we need to introspect

The toll on healthcare providers has not been insignificant, thought it perhaps pales in the face of utter economic devastation that millions around the world have suffered. But the daily stress of going to work and wondering whether the very skills one has honed over decades threaten to take you down as well, can be crippling. The little pleasures of clinical medicine are usually either wrapped in diagnostic and therapeutic triumphs – like the uneventful gliding of a breathing tube down a patient’s windpipe, or in simple human gestures, like leaning over and listening to a patient’s whisper while holding their hand. A tight squeeze is sometimes as reassuring to the doctor as it is to the patient. But SARS-Cov-2 succeeded in draining most happiness from routine care. Every patient is a threat, every healthcare provider could be an asymptomatic carrier. The House of God is silent as everyone tiptoes around their perpetual anxiety.

Despite communities around the world acknowledging these healthcare heroes through daily applause and public recognition, frontline clinicians often had no say in critical decisions that directly affected them, their patients and their working environs. This lapse has been particularly stark in India. A letter circulated early in the pandemic by the public health department of Mumbai’s premier medical college demanded that infected trainee-doctors explain how they got infected. A letter in mid-summer by India’s premier research agency declared that India will have a vaccine on August 15. Unproven remedies were reportedly being peddled, as matter of policy, for prevention and cure. Misguided overreach resulted in simultaneously crushing the private healthcare system in urban India and abandoning millions dependent on rural healthcare.

Such actions and inactions by those in charge risked the lives of patients and healthcare providers alike, around the world. In the United States, where I currently practice, the highest branches of government colluded to “let people get infected.” By the end of the year, most clinicians knew a healthcare provider lost to COVID-19. Globally, 7,000 had died by September. What healthcare providers are owed is not the clanging of pots, but accountability, and a seat at the table, as we rebuild our broken world.

Practicing clinicians, epidemiologists and infectious disease doctors were often underrepresented or completely absent in pandemic response planning, including in India. This pervasive lack of representation is not coincidental. In recent years, the commanding trust that physicians once enjoyed in society that allowed them to be powerful voices in daunting battles against landmines and nuclear weapons (where both efforts resulted in Nobels for physicians’ organisations), has been gradually eroded for a variety of reasons. While corporatisation of healthcare is the primary driver in the West, the highhandedness and sometimes outright quackery practiced by many providers in India has resulted in society’s skepticism of the profession. Even during the pandemic, the medical profession was often represented by those without relevant subject matter expertise, or sometimes, outright histories of prior mismanagement.

Fortunately, the design and dispensation of bad advice, bad policy, and bad medicine, even by those in white coats, was trounced by the clinical conduct of thousands at the bedside. For a fleeting moment, physicians might once again have the ear of their communities. To sustain this regained trust, introspection is however warranted. As a profession, our conduct has not been beyond reproach. “Cut-practice,” and India’s contribution to antibiotic resistance, are two enduring and shameful examples.

The misery foisted on society by the pandemic has resulted in urgent calls for change. But change in healthcare, in most countries, remains profoundly myopic and confined to digitisation, remuneration and algorithmisation. This hurried reductionist approach seeking to correct a supply-demand mismatch is unimaginative. As the pandemic has shown — and as have the gains in life expectancy over the past 100 years – the greatest strides will be made not only by treating, but by preventing malady. It is incumbent upon healthcare providers who have borne witness to the societal fissures that determined who lived and who died, to help re-build and re-imagine. They ought not to retreat to the wings.

There are remarkable examples of how Indian clinicians have engineered tectonic shifts in healthcare delivery in India, from making cardiac surgery affordable to the masses, to delivering scientifically sound medical care, door to door, in the remotest communities of Melghat, Gadchiroli, Jhagadia, Sehore or Bilaspur. The stories of Narayan Hrudayalaya, MAHAN, SEARCH, SEWA-Rural, Sangath or JSS have inspired legions of medical students in India and abroad because they capture what resonates at the heart of medicine – the spirit of service. A deep understanding of human ailment, and of the societal ills that cause it, is the foundation of their success.

This article first appeared in the print edition on December 31, 2020, under the title “Dear Doctors”. The writer is emergency physician and assistant professor at Harvard’s medical and public health schools