When Animesh Kumar (name changed) developed a rash that looked like pinpricks of blood, he immediately saw a doctor. The doctor diagnosed it as purpuric rash, got some tests done and prescribed medicines but Kumar was not cured. The middle-aged man then went to another doctor, who prescribed more tests and more drugs but to no effect. This continued for a couple of months till he came to visit senior physician and emeritus professor Dr Farokh E. Udwadia.

“I did not plunge into his medical history at first. Instead, I engaged him in talk,” says the doctor who has authored many books, including Tabiyat — Medicine and Healing in India and Other Essays. “As is my nature, I asked him casually if he smokes and drinks. He told me equally casually that he does smoke and he loves his gin and tonic. A bell rang in my mind. I could guess the disease he was suffering from and I suggested that he take his gin with lime instead of tonic.” A week later, the patient came back to report that he was now absolutely fine.

Purpuric rash can have many causes, including leukaemia, but it is also a side effect of quinine — the medication used to treat malaria. And, incidentally, tonic water contains quinine, says Dr Udwadia. He believes that the most important thing is to listen to the patient because a clue to the nature of the problem is usually hidden in the history of his ailment. “You have to hear him out and look for unspoken nuances of the disease,” he says.

The doctor was recently in Calcutta for the Prof. Shyamal Sen Memorial Oration at the Fifth Medicon International 2018. “That medicine is learnt best at the bedside by talking, feeling, examining the patient is something many doctors do not realise,” Dr Udwadia reiterated at the two-day conference organised by Peerless Hospital and BK Roy Foundation, the Royal College of Physicians of Edinburgh and the Association of Physicians of India (West Bengal Chapter).

For ages, bedside manners — the art of treating a patient by listening to his problems and physically examining him — has been the best way to healing. But the huge strides science and technology have taken in the recent past has led many medical practitioners to depend heavily on machines and diagnostic tools instead of going by what they see, hear or feel. History taking and clinical examination have now taken a back seat.

“Medical science has advanced a great deal and this has lead to a tendency for over investigation,” says Dr Debasis Datta, director of gastroenterology at the Fortis Hospital in Calcutta. “Doctors should spend 10-15 minutes with the patient to take a history and do a physical examination. This will help them ask for the appropriate tests.” Ordering a raft of investigations instead of a confirmatory test is taking the easy way out.

“Medicine has divulged from its path. The human being is forgotten,” Dr Udwadia regrets. “Medical practice has an abstract quality that heals the patient. Technology cannot be a substitute for clinical examination or the bond that a patient shares with his doctor — it is this bond that takes away distress or anxiety and healing begins before any medicine,” he adds.

Dr Udwadia warns that diseases do not manifest the same way every time. “Each patient is different and their reaction to a disease is different. No machine can analyse such a difference. But a good practitioner would chat with the patient, sieve out the relevant information and know in which direction to head,” he says.

It is also important to question a patient as, sometimes, much of the problem is in the mind and not the body. “Looking at the patient in entirety is of utmost importance,” he says. “The flush on his face or the shape of his nose, or the colour of his eyes might make you wonder why he is looking like that,” he adds. Good clinical judgement is the hallmark of a good physician and a doctor’s bedside manners should be such that a patient begins to heal just by seeing the doctor.

“Medical practice should give hope to the patient,” says Dr Udwadia. “It should bring faith. A patient should be treated with compassion. A medical practitioner should know what to say and what not to say,” he continues.

It is not only important for a doctor to learn the science of cure but also, as Dr Udwadia says, “the art of healing”. That, according to him, is the ability of a doctor to hear an unspoken nuance of a disease which no machine, no gadget can catch. It is an intuitive grasp that only a good physician has. And yes, the art can be taught.