Towards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today
Contents: Preface. I. Genealogies of Medicine in India: 1. What Makes a Disease Marginal: Tracing the History of Kalaazar/Anand Zachariah and R. Srivatsan. 2. PTSD, DSM and India: A Critique/K. S. Jacob. 3. Medicine and Government: Histories in the Present/Susie Tharu. II. Health in the Time of Development: Primary Health Care, Nutrition and Population Control: 4. Working the Contradictions: Three Decades/Sara Bhattacharji. 5. Andhra Pradesh: Ground Level Observations/A. P. Ranga Rao. 6. The Career of Hunger: Critical Reflections on the History of Nutrition Science and Policy/Veena Shatrugna. 7. Different Readings: Demography and Population Control/Sheela Prasad. 8. Development and the Administration of Public Health: An Overview of Contemporary History/R. Srivatsan. III. Tertiary Care Medicine, Evidence Based Medicine, Pharmaceuticals and Cost: 9. Rethinking Organophosphate Poisoning/Suicide in India/Anand Zachariah. 10. Development of the Cardiovascular Epidemic in India and Inappropriate Tertiary Care Treatment Guidelines/Anand Zachariah. 11. Drug Pricing and Access to Health Care: Some Issues and Options/S. Srinivasan. IV. Thinking with the Patient: 12. The ‘Intractable’ Patient: Managing Context, Illness, Health Care/Lakshmi Kutty. 13. Patient Questions/Duggirala Vasanta and Seemanthini Niranjana. 14. After Ervadi: Healing and Human Rights in the Context of Mental Healh/Jayasree Kalathil. V. Resources of Practice: Calibrating Medicine to the Needs of Patients: 15. Rethinking Practice(s)/Susie Tharu. 16. Practice in the ICU: The Case of Organophosphate Poisoning/Sujoy Khan and Anand Zachariah. 17. Peoples’ Struggles Producing a Curative Public Health for AIDS 299/Anand Zachariah. 18. Reclaiming Primary Care: Managing Depression and Anxiety in a Different Framework/K. S. Jacob. 19. What Constitutes Evidence Based Practice in Rehabilitation?/Duggirala Vasanta. References. Index.
High medical costs, the impersonality of technology-intensive speciality medicine and the difficulty in accessing curative primary care constitute a crisis for medicine in India. Towards a Critical Medical Practice is the outcome of a dialogue between a self-critical medicine and the new social sciences that offers original perspectives on the crisis.
A set of historical studies provides fresh insights into the dilemmas that surround cholera, kalaazar, post-traumatic stress disorder, ischemic heart disease, and undernutrition in contemporary India. Another group of papers argue that the public health focus on large-scale preventive programmes has resulted in the underdevelopment of primary care in the curative mode. This deficit in curative care is targeted by the new corporate hospitals that adopt as standard an expensive and inappropriate form of tertiary care that is marketed globally. Doctors trained in a tertiary setting are ill-equipped to provide appropriate medical care in any other context. This book is a path-breaking study which captures the drama of the crisis as mirrored in the lives of the poor battling illness on an everyday basis.
Doctors practice against this formidable backdrop of knowledge, orientation and elitism of modern medicine. The constant everyday work of translating knowledge and experience to address a local situation and do justice to the individual patient remains largely invisible and undervalued in modern medicine. We argue that theorising this practice, be it in teaching or in research, will open up new directions in health care and medical education.
