True to the Hippocratic Oath
Book Review

True to the Hippocratic Oath

A review of the book,‘Vital Signs’ by Dr. M.I.Sahadullah. Published by DC Folio

T P Sreenivasan

For retired life, most people look for a city that is familiar, unpolluted, with good roads and air transport, basic facilities for sports and entertainment, some greenery and water bodies and a few relatives and friends. Thiruvananthapuram suited us best from these perspectives, particularly compared to the other places within our reach like New Delhi, Bengaluru and Chennai. But the two institutions that helped us take the final decision to move to the city were the Golf Club and the Kerala Institute of Medical Sciences (KIMS) Hospital. The Golf Club was there even during my student days, but, as a student, I had not strayed into it even once and the KIMS was built only in 2002, just two years before we returned to Thiruvananthapuram. I thought the Golf Club would keep us healthy and if the need arose, the KIMS would take care of us. The KIMS had already established a reputation for being the most modern hospital in Kerala and having a team of globally trained doctors.

Soon after our arrival in our new home, we met two very pleasant and friendly people who built KIMS and turned it into one of the most modern and efficient hospitals in India, Dr. M.I.Sahadullah, the Chairman and Managing Director and Mr.E.M.Najeeb, his brother and Executive Director of KIMS. We also met the friendly and cheerful Padmasree Dr. G. Vijayaraghavan, the Vice Chairman of KIMS and a top cardiologist. Our paths crossed in the social, management, cultural and sports circles and we became friends and learnt to like them without any first hand experience of KIMS for more than eight years.

A year ago, my wife, Lekha, had to be brought to KIMS following some persistent pain in her left arm early in the morning. We contacted KIMS and sent word to the Chairman and others that we were going to the Emergency there. An array of medical personnel received us and Lekha underwent all the tests necessary in such a situation. Having no evidence of any serious illness, the investigation became more intense and elaborate and at one stage one of the doctors suggested MRI to exclude any invisible problem. In principle, we did not object, but there were some practical difficulties for Lekha to take the test and she was also nervous about it. Various suggestions were being made how to make the MRI possible. At this point, Dr.Sahadullah walked in with his usual smile and courtesy, held Lekha’s hands and said that he had seen the results of the tests and there was nothing wrong with her. She then said she was having difficulty in undergoing MRI and the doctors explained why it was necessary. He heard the doctors, looked at Lekha and said, “We are not doing any MRI on you if you do not want it.” The doctors were stunned by the decision and we were also surprised that Dr.Sahadullah took such a decision, which would deprive the hospital of some legitimate income. He looked at me and said, “the doctors do not want to take any chances, but in this case, I know Lekha is fine.”

Much later, when Dr. Sahadullah’s first book, ‘Vital Signs’ was launched by the Kerala Governor and I had a chance to read the highly readable and elegant volume, I realised that Dr.Sahadullah is not only a highly qualified and professional physician and medical entrepreneur, but also someone who straddles the old method of touching, feeling and using the simple stethoscope rather than the new method of the machines diagnosing and the doctors merely following the technical directions. The very first chapter of this book, which he claims is neither an autobiography nor a book on medicine or health care is about the change in the practice of medicine in India. He has embraced technology fully in his hospitals, but remembers nostalgically of the old days when diagnosis was more an art than a science. “The various aspects of physical examination-- touching the patient, using the stethoscope to listen to body sounds, doing a bit of percussion, feeling the abdomen, examining the nervous system and so on-- happen to a much lesser extent today.” This is very unfortunate as it pushes up the cost of care since patients are often asked to do tests they do not really need and the reliance on technology limits the doctor’s ability to build a relationship with the patients. The decision that Dr.Sahadullah took in the case of Lekha was part of the KIMS philosophy of being friendly to the patients. He also reveals in the book that unlike many hospitals, KIMS does not fix quotas for doctors to earn money for the hospital.

Dr.Sahadullah explains the “KIMS difference” as the emphasis on people and practices. KIMS has scrapped the widely followed health care sector conventions such as commissions to doctors for patient referrals, laboratory tests etc. Principled discipline is the secret of the KIMS success.

The author dwells at length on the use of IT at KIMS and explains how IT itself has changed in the health sector. From playing a supportive role, IT is increasingly moving centre stage. KIMS believes that technology helps diagnosis, but tries to retain the primacy of doctor-patient relationship. It is not IT that affects the traditional relationship, but the way the doctors use it. Technology is supposed to help the healing touch. It should also be remembered that machines can also make mistakes and so the doctors should apply the corrective measures as necessary. KIMS is already experimenting with AI, IOT and robotics, but these technologies must be shaped to retain the human touch. “For now, I believe that machines are great, but man has no equal,” says Dr.Sahadullah.

The book is a virtual store house on the principles of medical practices and their likely evolution, a step by step guide for those who want to build hospitals in the future, the experience of operating in various gulf countries and the use of technology in medicine.

The most charming part of the book is its autobiographical content. The glimpses that we get of the growth and evolution of a young physician to a legendary health care specialist are evocative and nostalgic. He is generous in describing the contribution of his mentors, his colleagues and his parents and his children. It is obvious that he has found time, in the middle of his multifarious responsibilities, to be a family man, who devotes his time for his children and grandchildren. He is also at the centre of humanitarian and management activities and a familiar face in art and cultural fora. I know he reads a lot as I get comments from him on my columns and books. If a doctor can pay attention to strategic thinking and education, he is no ordinary doctor. And that shows in the easy style of his writing and his ability to bring the intricacies of medicine to the lay reader.

The ‘Vital Signs’ should not be consigned only to the medical libraries, but should stay on the shelves of those who wish to learn all that happens in the medical field and to know how someone keeps his medical practice strictly within the Hippocratic oath.