Diary of a young doctor(part 6)

(Published in The Friday Times on 17th August, 2012)

Medical Science, like other disciplines of science, is a constantly evolving subject. New discoveries are being made, new ways to treat and look at diseases are being researched and newer drugs are being introduced on a daily basis. But the medical profession in Pakistan is lagging far behind the rest of the word in innovation and research. Very little, if any, research is being done by public sector hospitals and medical colleges. Apart from the Aga Khan University and Shaukat Khanam Hospital, there are no recognizable research centers in the country. Due to this issue, most of the books we consult during MBBS are written by Western or Indian authors.
It may come as a surprise to the reader that doctors in Pakistan are required to do research as part of their curriculum, both at the undergraduate and post-graduate levels. The ground realities, though, are very different. Very few of the "researches" done by Pakistani authors are published in international publications. On the undergraduate level, the research is mostly very basic and does not require much critical thinking, nor is it up to an international standard. The Community Medicine departments (responsible for overseeing research) ask students to choose from a particular list of topics on which research can be done. No funding is provided for the purposes of research. Students usually take shortcuts just to fulfill the academic requirement, and the matter is over after the final exams.
On the post-graduate level, where research is an important tool in the rest of the world, Pakistani doctors do not spend enough time on research topics. Most of the topics are re-hashed versions of the same old 'traditional' things. A grand sum of Rs 2,200 can get you a good synopsis on your chosen topic. Plagiarism is not thoroughly checked, so liberties can be taken in that regard. I questioned some of the senior doctors about this trend and they pointed out a few factors responsible for this problem.

The foremost issue is financial. Most post-graduates do not have job security and often have to work at multiple hospitals. In addition, they do not get any kind of funding for the sake of research. In such conditions, all they do is look for shortcuts to fulfill the academic requirement. In Shaukat Khanam Hospital, doctors are paid handsome salaries and have job security, resulting in some serious research work being done there. The proposed Service Structure that was the demand of doctors during their recent strikes is a much-needed step as it would at least provide job security, if not lavish pays.

The second most important reason for lack of research is the absence of critical thinking from our curricula. Research is borne out of questions about persisting problems and requires finding solutions to problems. We, on the other hand, learn and see throughout our academic life that 'he/she who crams the most, achieves the maximum marks'. From nursery school all the way to the final year of MBBS, we learn how to rote-learn particular texts and then regurgitate them in our exams. Questions are discouraged at almost every level and many teachers think it a disgrace if they do not know the answer to a student's question. In addition, there are almost no research societies working in medical colleges. The only one that I encountered was a small society working out of Punjab Medical College, Faisalabad.

The third factor in this regard is the lack of teachers and instructors who can guide students about research. This problem is present both in medical schools and in the College of Physicians and Surgeons, the premier body that awards specialization degrees in Pakistan. In many cases, the supervisors for research are not well-versed in the art of evaluating a research paper as it is very different from an examination paper.

Despite all these problems and glitches, there are still some success stories. Pakistani doctors, particularly surgeons, have developed many indigenous solutions to the problems they have faced over the years. The need of the hour is to promote critical thinking and research among the medical community so that Pakistani doctors can compete on an even keel with their international colleagues.

Diary of a Young Doctor(part 5)

(published in The Friday Times on 27th July, 2012)


"I am really thankful to you doctor sahiba, you saved my daughters' life today," said the mother of a young woman to one of my female colleagues.

The very next day, another attendant had this to say,

"You doctors are murderers. You don't know how it feels when your loved ones die. You have killed our young brother. We will never forgive you."
Both of the above-mentioned statements reflect a common misconception in our society, that doctors are supposed to be messiahs who save lives. I may have to face the wrath of some of my fellow professionals for saying it out loud, but this can't be farther from the truth. During the five years of medical school, followed by countless years of medical training, all we learn are a set number of protocols to follow. There is no subject or even a chapter dedicated in any of our books on 'How to Save a Life' (excuse me for the reference to a song with the same name by the band The Fray). The main problem with this assumption is the immense responsibility it places on the shoulders of the attending physician/surgeon. Doctors, in general, safeguard the best interests of their patients but having the mantle of 'saviour' placed on their shoulders is more than a little unfair.
As a result of the 'messiah' label, doctors become the automatic fall guys when a tragedy occurs. Doctors are obliged to do their best, regardless of the expected results, and when their efforts fail, the first impulse of the attendants is to blame the doctor for the demise of their loved one. I am not saying that medical science is guesswork; but why is the medical profession considered a "calling from God"? It is high time we learned to differentiate between a profession and a calling from God. Doctors are "working" in hospitals. They aren't on a divine mission to save everyone who comes their way. They provide a service and in return expect to get paid for it. (And we know how that's gone done in our country.)
When doctors announced a strike to demand for a better service structure, the widespread reaction was that doctors should be philanthropists who put others before themselves and don't ask for a compensation package in return for the time they have invested.
To quote the columnist Ayaz Amir: "The young doctors' strike was not about doctors versus ailing and suffering humanity. In the Islamic Republic suffering humanity is a handy cliche, readily invoked to score a political point and as readily consigned to the upper layers of forgotten memory when the need passes. If anything, this strike was doctors versus a hidebound bureaucracy, one of the most ossified bureaucracies in the lands which can claim descent from the British Raj."

During the strike by doctors, one of the major objections was that doctors were supposed to provide health services in any condition, as they have taken an oath to do so. Let me make it absolutely clear that in the original Hippocratic Oath that was formulated around the year 425 BC, there is no provision that makes it mandatory for a doctor to provide health services to anyone who wants them. In the revised Hippocratic Oath, constituted by the British Medical Association, one of the points declares: "I will do my best to help anyone in medical need, in emergencies. I will make every effort to ensure the rights of all patients are respected."
Similarly, according to PM&DC (Pakistan Medical and Dental Council) Ordinance of 16th July 2011, Section 9, Sub-Section 2 (a) : "A medical or dental practitioner shall be free to choose whom to serve, with whom to associate and lay the timings and place of professional services to be provided."

While Sub Section 2(b) reads: "A medical or dental practitioner shall not be bound to treat each and every person asking his/her services."
In my opinion, one of the underlying causes of outrage against doctors during the strikes was the "messiah" proposition. How can someone who is supposed to "save lives" go on strike? As a nation, we are prone to miracles and magical rescues; we are always hoping for some messiah to come and save us from the "mess" we are in. This messiah complex has in the past led to acquiescence to dictators and demagogues. We, as a nation, need to mature and start believing in processes and institutions, not saviours. Bottom Line: Doctors are not messiahs; they are ordinary professionals doing the best that they can.

Reflections from Pakistan India Social Media Mela 2012

(an abridged version published by Express Tribune Blogs on 16th July, 2012)

Question: What is the one common thing between a writer from Mumbai, a Journalist from Delhi, a famous film maker from India and a Junior doctor from Lahore?

Answer: The fact that all of them loved hearing Iqbal Bano(it was actually Meesha Shafi, as pointed out later by Jugal Mody) sing 'Dasht e Tanhai main' on the radio, at wee hours in the morning while waiting to get CNG at a gas station in Karachi. 

For me, that one moment captured the spirit of Pakistan India Social Media Mela 2012. No wonder the slogan of the event said, “Faasla Na Rakhen, Pyar ho Jaanay Dain’(Translation: Overcome distances, Let love happen)

Organized in Karachi by PeaceNiche, in collaboration with the United States Consulates in Lahore, Islamabad and Karachi, it was supposed to be a gathering of social media enthusiasts from India and Pakistan. This being Pakistan, the criticism leveled at the event started much before the event itself. It was an invite-only affair and most people who were invited were recommended by other people. Participants from Lahore and Islamabad were sponsored by U.S Consulates in Lahore, Islamabad and Karachi for their travel and accommodation.

It was my first visit to Karachi and I was really excited by this opportunity. I boarded the plane from Lahore airport on the evening of 12th July, along with the rest of participants from Lahore. The visit was not only an opportunity to interact with new people but also to get a respite from the hectic schedule at the hospital. During the flight, I had a good, long chat with my seat mate whom I discovered to be a fellow participant. I got some flak after the plane landed, from assorted uncles who were unfortunate enough to have gotten seats around us. The first thing that I noticed after landing in Karachi was the wind. We were transported to Avari hotel and allotted rooms. When I reached my designated room, I had to pinch myself to judge if I was not dreaming. The rooms were spacious, comfortable and had attached baths separated by glass walls.

We were offered BBQ dinner at the top floor of the hotel. That was where we first met fellow participants from India including Onir, Karuna John, Jugal Mody, Venket Ananth, Sabbah Haji, Annie Zaidi, Raheel Khurshid and Sanjay Rajoura. I immediately struck cordial notes with one of them because of me being a vegetarian. Later, I took part in an interesting discussion about Marxism, Class Struggle and Pakistan Movement taking place at an adjacent table.

The next two days were one of the best that I've had.  Despite being an adopted Lahori, I didn't miss Lahore for a moment. I wouldn't have met many of favorite people at one place if I had not come to the mela, including Nadeem F Paracha (one of my mentors), Ali Chishti, Marvi Sirmed, Beena Sarwar, Mohsin Sayeed, Muhammed Hanif, Faiza S Khan, Musharraf Ali Farooqi, Declan Walsh, Amir Mughal, Murtaza Solangi, Hassaan Belal a.k.a mighty, Sana Saleem, Ali Arqam, Zebunnisa Burki and the wonderful people from across the border. At the start of first day's session (around 9 a.m. which was an inconvenience for many people) Senator Rehman Malik, usually at the receiving end of mockery by social media people, was generously praised for urgent attention to the visa problems faced by guests from India.

The sessions were mostly insightful and informative but I personally enjoyed the off-session activities where I got the chance to interact with some amazing people.

Some of the memorable sessions dealt with online activism, role of social media in education sector, use of non-profit for non-profit organizations, online activism, Pakistan-India relations, ‘Slactivism’, impact of party politics on Social Media, Internet Censorship, Cyber-Bullying and Twitter as the new Newsroom. 
 I was a panelist at the session 'Fight Club:Rise of the Troll' alongside Bina Shah, who had come fully prepared with research, Mohsin Sayeed, star of our show and a delightful presence throughout the mela, Raza Rumi and Rab Nawaz, editor of the magazine Laaltain and member of Khudi Pakistan. Some sessions were, indeed, boring but that is how things work usually. Due to my involvment in the recent doctors' strikes, I had plenty of questions to answer. I was branded 'the revolutionary doctor' by Sher Ali, an Express Tribune reporter and 'Hartaali doctor' was my nick name. After the first day, the event was declared open to everybody because of the quips about elitism and exclusion.

There was a Qawalli session after first days’ proceedings and it featured Fareed Ayaz and Abu Muhammad, the best Qawwals in Asia. They enthralled the crowd with their renditions from Sufi poetry.
There was a standup comedy act on the second day by Sanjay Rajoura and he left the audience rolling on the ground with his observational comedy about Facebook albums, Indian Cricket and some social peculiarities. He received a standing ovation at the end.

Contrary to popular expectations, the event did NOT offer a solution to the Kashmir Problem, brought an end to killing of Shias and Hazaras in Pakistan, decreased the level of radicalism in Pakistan or ended the hostility between Pakistan and India. Kashmir was mentioned, but only as a barter for Coke Studio by Sanjay in his stand up act. The issue of persecution of minorities was discussed in detail and panelists included members from Ahmedi, Hazara and Christian communities. It was a social media event, not a Track 2 diplomat meeting. There were many Hazara participants there as well, which was encouraging. It was not a kitty party and for the record, only two women were actually wearing Sari(Even if they were, Whats wrong with that?), so over-generalizations have to be avoided.

 It was a unique coming together of people who know each other mostly by twitter names and such events should take place at least once a year. It was a tremendous effort by Sabeen Mahmood and her team at PeaceNiche, and I would like to thank and congratulate the team at PeaceNiche and the U.S Consulate staff for their co-operation and hospitality. I would also thank my new friends from Karachi and India, for their love and company. I left the event with a heavy heart, new friends and acquaintances and countless good memories.  

A big shout out to my new friends
Faizan Lakhani, FurSid, Aroosa Shaukat, Sheru, Tuba, Shiraz Hassan, Osama, Faheem(@smokenfog), Yasser Latif Hamdani, Shahab(@UncleFu), Rab Nawaz, Sara Muzzammil,  Awais Aftab, Bilal Tanweer, Salman Lateef and Zeeshan Haider. 

Diary of a young doctor (Part 4)

(published in The Friday Times on 13th July, 2012)

Pay Up
"Please give me some money, I'm hungry and don't have any money to buy food," said the beggar.

"I wish I could, my friend, but I earn less than you do," was my reply. And I was not bluffing. 

There is a simple basic rule that governs almost all professions in the world: you work and that earns you money. There are strings attached to this simple fact according to diferent fields but the basic notion remains the same. Soldiers claim to fight for the country, police officers risk their lives for maintaing law and order, public servants work (or at least they are supposed to work) to provide services to their countrymen. At the end of the day, however, they all get paid for it. From the highest offices of the country to the lowest, from generals to chowkidars, from CEOs to clerks, the maidservants that work in houses, sewage workers, technicians, sales boys, they all get paid for doing their job. But in present-day Pakistan we are making one big exception to this rule: doctors.

I have chronicled the lives of young doctors and have described the trials and tribulations associated with their job. It is hard to believe that despite all this hard work, most doctors working in public sector hospitals are not paid. Imagine a person with 17 years of education, working 28 days a month, doing 30 hr/48 hr duties, and earning a grand total of zero rupees per month. 

Imagine a life with no pay, no job security and no health insurance (given that we deal routinely with HIV positive and Hepatitis C infected patients). All that keeps us going are the 'thank yous' of patients and a hope that someday, things will be better. 

After the doctors' protests last year, pays were increased. This does not mean that everyone is getting that pay. In the department where I work, there are 28 people working as House Officers and around 30 as Medical Officers/Post Graduate Trainees (PGRs). Out of 28 House Officers, only 8 are on the paid seats while the remaining 20 are working on 'honorary' basis (there is not much honor involved; it is a euphemism). Similarly, out of 30 Medical Officers, only 15 are getting paid. The situation is similar or worse in other departments and hospitals across Punjab. People working on honorary seats perform equal duties, do everything as others do, the only difference is that they are not paid for doing that work. This is a unique and frankly disgusting way of treating a professional, and there is no precedent for it anywhere in the world. Apart from interns at offices, everyone gets paid for their jobs. At times, even the Senior Registrars, after 10 years of medical training, have to work on honorary basis. 

There is an inside story to this practice. Theoratically, the seats in wards of teaching hospitals are preferably given to the graduates of the institute that the hospital is attached to. This results in unequality at times because graduates of other institutes opt for institutes in bigger cities. In the case of Punjab, graduates from all over the province prefer to do their clinical training in either Lahore, Multan or Rawalpindi. There is also the issue of non-residents. If a resident of Lahore got admission in Rawalpindi Medical College or Nishtar Medical College, he/she would prefer to complete his/her post-graduate training in the native town. Due to this shuffling, there are more candidates for less seats and departments employ different people on honorary basis. The merit list for giving a job for post graduate training starts from graduates of the same institute. Second on the list are graduates of other government institutes and lastly, the graduates of private medical colleges, including the ones in China and Russia.

There are ways that people bypass the merit system, because in Pakistan there is a single key for every lock: Sifarish. If you have the requisite Sifarish, you can bypass the merit and get a paid seat in your desired department. 

To cope with the economic pressure due to lack of any pay, doctors from public hospitals look for jobs in the private sector which forms 80% of our health sector. As a result, most of the unpaid (and in some cases, even the paid ones) do jobs at private hospitals in the evenings and in public hospitals in the morning. After living for more than 25 years on the largesse of your parents, if you still do not earn anything on your own, it reflects poorly on you. Also, during post-graduation, a lot of doctors are tied in the knot of marriage and it is difficult to ask your parents for sustenance of another person while you earn nothing. I personally know some people who delayed their marriages because they did not have the means to support a new member of the family. In some other cases, the young doctors were the only source of income for their families and had to wait till completion of their post graduation to marry. 

This system of 'honorary' jobs should end as it is nothing but a kind of slavery.

Diary of a Young Doctor(part 3)

(published in The Friday Times on 29th June, 2012)

Diary of a Young Doctor III

"Please guide us, doctor. We have come back because the local dispenser [quack] refused to administer the injection you wrote for our son, saying it is too 'heavy'." 

I was busy making the 'discharge form' of a patient when that couple came towards me and said those lines. Their teenage son had been discharged yesterday upon their request, and I had prescribed an injection that he needed every day for the next week. The couple said they would get their son the shot through a dispenser in their locality. And they were back the very next day.
A doctor can, just by clicking on the computer screen, get free medicines for needy patients


This is not a unique situation. Apart from managing patients feigning abdominal pain in the emergency ward and waking up during the "on call" nights after every hour to change a transfusion bag, this is what young doctors do in "routine". A routine day comprises duty of about 6 hours, from 8 in the morning to 2 in the afternoon. We start the day by checking patients on the beds allotted to us and by writing down the DPNs (Daytime Patient Notes). This is followed by a survey of our work and additional examination by our immediate seniors, the Medical Officers. After that, there is the ward round by any one of the designated consultants/specialists. During the round, the consultants listen to the medical history of patients from house officers or medical officers and look through the investigations carried out previously. Then, according to the situation of the patient, investigations or different drugs are advised which are added later to the charts by House Officers.

If the patient is newly admitted and can't buy medications on their own, there are two ways of getting them free medicine. There is a list of medications that are provided to our wards every day by the hospital. They include most of the commonly required drugs, and a doctor can, just by clicking on the computer screen, get free medicines for needy patients. Another way is through the Medical Superintendent (MS) of the hospital. For that, the patients' file has to be signed by the MS himself, which is not a hard thing to do. Then there is the problem of urgent investigations. For that, house officers have to counsel the attendants and sometimes have to get involved themselves to get those tasks done through the emergency department. At times, the bureaucracy of it all can get in the way and frustrate patients.
I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy


As in the rest of Pakistan, a patient is likely to get sufficient attention (which mostly means more than normal) if they know someone in the hospital hierarchy. This doesn't mean that doctors don't care for their patients; it's just that we find it difficult to divert our energies where they are not required.

This 'protocol' business can turn ugly. Many a times I have seen patients who think they are not being treated fairly threaten the doctors by mentioning political figures or members of the bureaucracy. It happens particularly frequently in the hospital where I work because we have to deal with all kinds of government employees and their kith and kin. According to one of my seniors, even if the gardener of CM house brings a patient to the hospital, he expects to get 'protocol' equal to that of the CM himself.

Hospitals are great places, not only for learning medicine but also for learning about the different shades of life. I would like to mention some of the most interesting cases I have seen in my brief clinical career.

The fiancee with the headache before her FA exams brought to the emergency by her very concerned fiance, the CA student who had not eaten anything for a month due to some kind of love affair; the 65 year-old woman patient who insisted on smoking despite the disease in her lungs; the helpless relatives of a 70 year-old woman who had to get dialysis but couldn't find the hospital where it was urgently available; the 50 year-old woman with tuberculosis of the meninges (brain coverings) and an untiringly colorful vocabulary; the madrasa student who sat for his Dars e Nizami exam while he was admitted in the hospital; the women loudly reciting Quranic verses around a very sick patient and freaking out the doctors; a 15 year-old boy spending most of his time around his ailing mother in the ward and running around taking her samples for laboratories; the young patients (mostly girls) with acid/bleach intake for suicide purposes and the attitude of their families towards them; and all those patients who are never satisfied when they are prescribed pills and demand injections and drip infusions just to feel medical; and all the drug mules who are accompanied by police or custom officials and deny any wrongdoing until the last minute.

There are also issues among various departments in the hospital that cause unnecessary delays in diagnosis and treatment of patients. The Radiology and Pathology departments provide services to all the rest of the Hospital, and are indispensable in the management of patients. If the same tests are to be done from private labs, the cost is not affordable for most of our patients, who belong to the lowest strata of the society economically.

I would also like to mention that there are almost no holidays for young doctors during their house jobs. In the department where I work, we only get 2 holidays in a month, both Sundays. Apart from that, we only get one emergency leave per month.

 

Diary of a young doctor (part 2)

(published in The Friday Times, on 15th June, 2012)


There was a frantic knock on the door of the doctors' room. A half-asleep lady came in abruptly. It was 2 o'clock in the morning and there was absolute silence in the rest of the ward. The lady gasped and said, "Dr Sahib, the condition of my patient is serious, can you please come and check her?" I had no option but to get up from the couch I was lying on, get my stethoscope and accompany her to the bed of that patient. As it turned out, the lady was a patient of liver failure and was having pain in the abdomen. After a brief checkup, I wrote down a simple ant-acid and asked the patient to take some water. Problem Solved. Sleep be damned.

The above-mentioned scenario is one of the many that we have to endure during our 28-30 hour long ward duties, also known as "long calls". After a regular day at work, the whole ward becomes the responsibility of 4-5 doctors who are said to be "on call" while the rest of the doctors go home. This duty has to be done once a week and at a weekend once a month. The regular tasks that we are required to perform during our calls include noting down blood sugar levels of diabetic patients, monitoring blood pressures of any serious patients, doing a routine checkup of patients in the ward, dealing with occasional complaints (like the one mentioned above) and lastly, to oversee casualties that occur on our watch. We are required to be present in the ward at all times during duty hours, and it basically means little rest and little to no sleep. After every 5-10 minutes, there are knocks on the doctors' room and one attendant after another barges in to get the required "attention" for their patients. In many cases, the condition of the patient is "irretrievable" and it is difficult for both the doctor and the attendant to see the patient suffer. Most of the patients admitted in medicine wards are suffering from either chronic liver disease (due to very high prevalence of hepatitis in our population), tuberculosis in its various forms, stroke (known as 'brain hemorrhage' in popular culture), kidney failure, meningitis (infection of the coverings of brain), chronic pulmonary disease (due to long-term smoking) and fever due to infections. Patients are checked twice daily, once in the morning and once in the evening.In a country with so many health-related issues, negligible amounts of money are being spent on patient care in public hospitals. A lot of patients can be saved by provision of simple ventilators but the number of ventilators across hospitals in Lahore is no more than 100-150! Similarly, dialysis units and liver transplant facilities, which are considered routine in developed countries, are not easily available in most tertiary care hospitals in our country. The human aspect of being a doctor can be seen during ward duties, as doctors give their best efforts and energies to save the patient without having any relation with the patient. In many cases, young doctors work out of their comfort zones to treat the patient as well as is humanly possible.
Young doctors are the wheels upon which the health care system is working
The culture of attendants in our country is not only cumbersome but also problematic at times. Due to socio-cultural beliefs, more people are willing to stay with the patient than is necessary. The problem arises when doctors are inconvenienced by attendants craving attention, leading to neglect of other patients. Even when forced to leave the ward during rounds, the attendants are back as soon as the restriction is over. Last year, a team of doctors were visiting from the United Kingdom for a project and they were surprised to see so many attendants in our wards. They recounted that in the UK, attendants are allowed to visit the patients only during scheduled hours and even at those times, so many attendants were not allowed to visit the ward, ultimately avoiding the mess that we have to face. At this juncture, I would also like to point out that the running of emergencies and the wards is primarily done by the young doctors and they are the wheels upon which the healthcare system is working, despite all glitches. It is an unfortunate reality that most doctors working in public sector hospitals are not even paid for their jobs, making their work more worthwhile than it already is. As I wrote earlier, there is acute shortage of bed space in public sector hospitals. Last year, during the dengue outbreak, when the Chief Minister visited many hospitals including the one I work at, he was appalled to note that two and in certain cases three patients were present on one bed. Based on his instructions, patients were adjusted but it was a short-term measure and the situation remains the same. I personally have had to discharge patients at times because of acute shortage of space. I felt extremely bad doing that but the patients themselves wanted to go home and be comfortable. The toughest aspect of ward duty I found was the time of casualties. The usual scenario goes like this. Doctors are mostly aware of the patients who are having a really bad time and they try to counsel the relatives beforehand. When a distraught attendant comes running in, calling for attention, the concerned doctor rushes to assess the patient. When the patient is critical, the doctor calls his batch mates for help and combined efforts are done to resuscitate the patient. If the patient can't be revived, the protocols are followed and the attendants are informed about their patient's demise. The response of the attendants to the news depends on various factors including the age of the patient, disease of the patient and the quality of counseling done previously. In case of young patients, the reaction of the relatives is quite severe and I have seen my colleague's collars ripped off by an angry relative. Due to their inability to cope with grief, many attendants blame the doctors for the casualty of their patient, without acknowledging the work done by the same doctors when that patient was alive.
At the end of the day, it is not a fair world and a doctor can do only as much.   

Goodbye,Dr House

(published by Express Tribune Blogs on 6th June, 2012)

As the saying “all good things come to an end” goes, “House M.D.”, the brilliantly written show, ended last week. There have been numerous television dramas over the years based on doctors and hospitals including “General Hospital” from the 60s to “Scrubs” and “Grey’s Anatomy” during the 2000s. “House M.D.” embarked on a journey to create its own presence and niche when it first aired in 2004.

It is based on an ingenious but misanthropic doctor who is willing to cross all boundaries to solve a case. His actions are seen to be driven by his passion for medical puzzles and mysteries, instead of a general feeling of care and well-being for his patients.

The character is loosely based on Sherlock Holmes, the fictional character created by a Scottish physician and writer, Sir Arthur Conan Doyle. Dr House is a graduate of Johns Hopkins school of medicine and has served fellowships in nephrology and infectious diseases. In the series, Gregory House heads the Diagnostics Department at Princeton Plainsboro Hospital (PPTH), in New Jersey. The department takes only one patient at a time with barely any criteria for selection. Usually patients with atypical symptoms are dealt by the Diagnostic Department. Both the department and the hospital are, however, fictional.

In the first three seasons, his team includes Eric Foreman, a neurologist, Dr Chase, a cardiologist  (later head of surgery and then the department of diagnostics) and Dr Allison Cameron, an immunologist. Other important characters include Dr Lisa Cuddy, the administrator of PPTH and Dr James Wilson, an oncologist and the only friend of Dr House. House abides by one golden rule about patients and life in general – “everybody lies”. That is the reason he seldom talks to his patients or even believes in what they tell his team about their medical history.

Hugh Laurie, a British actor, plays the character of Gregory House and his acting attracted nothing but praises from the general viewers and critics. Despite his British accent, he effortlessly adopted the American accent throughout the show.The show was popular not only amongst people with medical backgrounds but also for aficianados of acting and drama. The character House is famous for his witticisms and there is a whole website dedicated to “House-isms”. I would like to mention some of the quotes here for all of us to enjoy and reminisce the intelligent humour we all will miss the most.

House: “Me and humanity, we got together too young.”

Patient: “How do doctors get this idea that you are better than everyone else?”

House: “Probably because of all that ‘pulling people back from the brink of death’, but its just a guess.”

House: “Treating for wrong diagnoses can result in side effects, like death.”

Chase: “The dream doesn’t mean anything. Can we start acting like it doesn’t mean anything?”

House: “Sure. We can also act like walls don’t mean anything. But then we’d hurt our noses.”

House: “Evolution does not work that way. You can’t talk legs onto a fish. If we’re going to go extinct, we’re going to do it drinking Scotch and driving muscle cars.”

House M.D. means more to me than a simple drama for the purpose of  entertainment, which it definitely provided its viewers with. I started watching it when I was in medical school and even now, when I am undergoing my clinical training, I still watch it. It evokes so many memories that I feel difficult to let it go, like many of its fans.

House M.D. will live on, even after it goes off air. It will and may have already inspired countless people towards the medical profession. It showcased the much-neglected human side of doctors emphasising on their human errors. With teary eyes, I bid farewell to one of my favourite television shows, House M.D.

My Tuesdays will be emptier without another episode of the show and if I ever develop any atypical disease, I would want someone like House M.D. to treat me. He may dismantle my hopes for living but at least he would not let me die due to a lack of effort.