On National Doctor’s Day, Dr Pankaj Chaturvedi – professor and cancer surgeon at Tata Memorial Hospital and one of India’s foremost anti-tobacco campaigners tells us that doctors need to set an example for the rest of society and eschew habits like smoking and drinking.
According to Wikipedia, the word ‘doctor’ originates from the Latin word of the same spelling and meaning. The word is originally an agentive noun of the Latin verb docēre ‘to teach’. Marcus Tullius Cicero said: ‘In nothing do men more nearly approach the gods, than in giving health to men.’
In my editorial I have chosen to highlight the ubiquitous role of physicians by becoming positive role models. For centuries, doctors stood tall as fine role models for their students, patients, colleagues and in their community. At every point of contact with other human being, doctors are ambassadors of healthy lifestyle and a positive icon.
Sadly doctors are human as well and by the early part of the 20th century, tobacco usage was very high amongst Indian physicians. It was common for physicians to smoke/chew tobacco while examining the patients, inside the hospital and in public. This was a reflection of high degree of acceptance for tobacco amongst physicians and society at large. Fortunately, with passing days, its usage is being increasingly looked down upon amongst doctors. It is increasingly difficult to spot a doctor smoking in public though it is still seen in certain parts of China, Russia and East Europe. However, rising use of alcohol amongst doctors is an area of concern and the topic that I will discuss this ‘Doctor’s Day’.
The issue of alcohol is similar to tobacco in several ways. Thanks to several decades of shrewd marketing, both continue as socially acceptable and profitable industries despite abundant evidence against them. There are about 2 billion people worldwide who consume alcohol and 76.3 million suffer from nearly 60 types of alcohol-related diseases that lead to 1.8 million deaths. Despite this, I’d estimate that half of all the doctors drink alcohol beyond ‘safe levels’ though it’s hard to back it up with data.
A glimpse of this indulgence can be witnessed by attending the gala dinner / banquet of the medical conferences. It is well known that the attendance in such session is nearly 100% while attendance of the academic sessions is strikingly dismal. Though the definition of the ‘moderate drinking’ is mired in controversy, many doctors are comfortable convincing themselves that moderate drinking is safe. Most of them define their own ‘moderate’ levels! Moderate drinking per day for men is 2 drinks in US, 3 drinks in Netherlands, 4 drinks in France! Women folk are supposed to drink one peg lesser than men in their country to be classified as moderate drinkers.
The physician’s pro-alcohol attitude has also created a societal impression that encourages the vulnerable people to pick up the habit as a ‘tonic’ and allows fearless continuation amongst those that are already habituated. Cochrane review clearly reported that a brief advice by physicians to reduce tobacco/alcohol is very effective. Conversely, a brief advice proclaiming safety of moderate drinking may have disastrous influence. It is interesting that a downbeat industry has gained so much of acceptance by suppressing a mountain of evidence and succeeded in creating a positive impression amongst physicians. I am sure its consumption leads to actions that result in unintentional injuries or harm to patients.
While there is a strict law to curb drinking and driving, we need to see more punitive actions for those doctors found ‘harming and not healing’ under the influence of alcohol. Chronic alcohol addiction is bound to affect the psycho-motor abilities that are crucial to all physicians regardless of their speciality. It is proven beyond doubt that non-communicable diseases are negatively impacting individuals, communities, and countries are undermining the achievement of the Millennium Development Goals. In September 2010, UN member states passed the UN resolution, announcing that it will focus on common risk factors for vast majority of the non-communicable diseases – tobacco, alcohol, unhealthy diet and physical inactivity. In this hour of public health crisis, it is only expected that medical community leads from the front.
Firstly, they should not serve as proponents of drinking and secondly they should shun drinking at least in public. Doctors serve as role models to society and their counselling on any such issue will be completely ineffective if the patient does not see the same advice being followed by the medical community.
