Health Mastery

If by mastery one means dominance, then no medical specialty can be mastered. One can acquire greater and greater competence in that specialty but never mastery. The holes in our knowledge of the working of the human body in health and disease are so many that mastery is not possible. There are other reasons one of which is now in a dramatic display, namely Covid-19 on its rounds.

In the early 50s when I was an undergraduate in surgery, we used Baily and Love Textbook of Surgery. A couple of years ago I got a copy of the most recent edition of Baily and Love. The new one is twice the size of the old one and other than a few pages in the initial chapters, the book is entirely different. The changes that have occurred in one person’s career time are quite astonishing. There is no question of mastery when we have our hands full updating our knowledge.

You can gain great competence in a field but suddenly find that your area of specialization has deserted you. Before the 90s we general surgeons had a special affection for the operation of removing the gallbladder. The operation can be as simple as removing an uncomplicated appendix or it can turn out to be a nightmare. Many had great competence in dealing with these cases when something strange happened. The laparoscopic method of removing the gallbladder came into practice in the early 90s that left no abdominal scar other than a couple of puncture wounds. The patient was back home not after 10 days but the next day and at times the same day. Laparoscopic surgery needed a different set of skills than the open operation. Younger surgeons brought up in these days of changing technology took to the operation as ducks take to the water and our 60-year-old ‘master’ of the open operation was left out in the cold. This author writes with feeling for he was one of those left behind.

The mastery could be based on reasonings that later studies show was flawed. From the 50s to the 80s the most common abdominal surgery performed in most parts of the world was for chronic peptic ulcers. The theory was that high acid secreted by the stomach was the cause for the ulcer and following that reasoning surgery treatment for that disease was removing large parts of the acid-secreting parts of the stomach. That meant removing 3/5 or more of that organ. Patients in the affluent West with high meat protein in their diet could manage but when the same operation was performed in the Indian peasant the results were horrific. The Indian diet based on a high volume of rice was not possible with the shrunken stomach. The patients became anemic and so low in protein that their feet swelled up. Luckily, the drug omeprazole now appeared, and the acid could be reduced without recourse to surgery.

Feel free to contact Jitesh Gadhia for Health Mastery Session.