Of medically imposed changes in life style
Dr Govind Hoskeri -

Life style is as individual as we, the individuals are. At some stage certain people evolve even without traumatic episodes. Then there are certain people who refuse to evolve, trauma or no trauma. Even with the most traumatic incidences, which could in the normal course of events, some fail to see reason. That is the undercurrent of the dilemmas which force a change in life style at certain time or the other in the life of an individual.

At what cost this change in lifestyle is going to being effected? Is it going to extract an impossible pound of flesh? If that is going to be the case it can better wait.

Imposition of change in life at around the middle age is becoming almost a certainty for majority of the Asian community. The earlier lifestyle, replete with overindulgence in the ’so called’ unhealthy food and unconventional ways of having a go at success, are leading to disease conditions which require a drastic change in the life style apart from the medication. To tell you the truth it is the change in the lifestyle that brings about the desired effect of the drugs, rather than otherwise.

This imposition of change in life style is one of the ’most cruel’ forms of current medical approach in the cases where the treatment is not satisfactorily attained. That probably is an indication of the acceptance of inability to be of some ’real’ help. Since we insist on patient compliance, we can easily pass on the blame to the patient and literally wash off our hands, even if one of the medical sermons is not adhered to. Why is this so?

We all push ourselves hard to achieve the basic standards of living. And in a society where living is becoming one hell of a competition, the stress levels are very high. Add to this the newer concept of work culture that expects too many man-hours, poaching on the private hours. That is a perfect cocktail for cardiovascular conditions, which are on the increase in our subcontinent.

We inflict ourselves with the cutting edge of strong aggressive living and pay for it in the second innings. Can the trend be reversed so that a good first innings is followed by an equally good second innings? That is not cricket, our way, anyway. When we take into consideration the fact that India accounts for 25 per cent of the total number of diabetic population of the world and the cardiovascular diseases are on the upswing in the Asian subcontinent, something radical needs to be done to address these problems. The statistical data is likely to be more than what is available. It could just be the tip of the iceberg.

These conditions, when detected will necessitate a drastic change in the life style. Is there a statistically significant difference in the urban style of living vis-a-vis the rural style of living? On the face of it, it looks like that the urban life style is more likely to be the culprit. I have my own doubts. One of the reasons why medical practice flourishes in the industrialized urban India is the availability of these reimbursement schemes. Without this facility it would not be possible even for the ’higher middle income’ groups to avail medical attention. Apart from ’certificate’ generated additional revenue for the doctors, it has helped many unsuspecting otherwise healthy folks to be the victims of diabetes and hypertension one fine morning. That happening at an age when they are really reaping the fruits of their toil becomes a major cog in the wheel.

They are thrown into a quagmire of investigations and treatment. The most daunting task of these treatment modalities is the change in the life style. The cost effectiveness of the change in the food habits demanded by the nutritionists is a further cause of agony. Try eating one pomegranate and one papaya everyday and let me know where it hurts most. No big surprise that the fruit stalls in front of the hospitals make merry. They catch them at their most vulnerable moment. This is only one example.

This may be necessary and well meaning. But it makes such huge demands on the person as an individual that some times it becomes torturous. Some people take to this change as fishes would take to the proverbial drink. Generally this change is sought in such a hurry that the whole exercise becomes self-defeating. It puts additional stress and the very purpose for which the change is advocated is defeated. No solace. Some will consider consulting doctors of alternate systems of medicine, who advocate the same things in such a way that it does not sound as brutal as it sounds. They simply tell you that ’if not adhered to the medicine with a strict regime of diet and denial of worldly pleasures’ it will not work. It is a totally different scenario.

You would really wonder how a person seeking such ’alternate medical advice’ is willing to change. There is another set of doctors who would claim results only after ’chronic treatment’. Very smart! They have all the time in the world to interact with the patients to get them to suit their ’structure of treatment’ and bring in the desired change over a chronicled time stretch that can be kept on stretching. Allopathy is at a disadvantage on these counts. Patients have no patience. Allopathy has to deliver. Otherwise face the prospect of losing the patients. This is particularly so, as far as the consultants go.

A general practitioner has at least the advantage of knowing the patient and may have some thing up his sleeve to see that he is not deserted. But as is the case everyone has ones own ways of dealing with this type of ’ditch’, the consultants keep a network of like-minded consultants who won’t mind “close monitoring” the patient by way of consecutive consultations. The words like Monitors and monitoring rhyme well with ’moneytering’. There is treasurable poetry in medicine also. Another constant feature in front of the major hospitals is the presence of presence of the parrot card players. They are as constant as the ’Jadi bootiwala doctors with their pavement spread of medications. They are the last resort of the change ridden human suffering. For some reasons the ’weighing machine-walas’ are also found around the hospitals. They drive the health consciousness far better than the official signatories.

All this leads to a change in lifestyle, which unfurls a chain reaction. Weighing machines, measuring tapes, blood pressure rading gadgets and a host of other household equipment, astrologers included, replace the good old thermometers and hot water bags. The patient shuttles in between the far left and far right of medical opinions and the change is brought about willy-nilly. By that time the doctors also start complaining... like the wife who strives so hard to change (sorry, bring about a change in) the husband and then complain that the fella is no more what he was. What is the bickering all about I fail to understand? You need patients to commit mistakes, to keep life going on.

(The author is associate professor, anatomy, Seth GS Medical College and KEM Hospital, Mumbai. He may be contacted at hoskeri@rediffmail.com)