What Is A Doctor’s Responsibility?

Questioner: I was looking into your teachings and I’ve been reading your book Truth Without Apology, and you mentioned unlearning. There was actually a particular quote in your book which said, “Real learning means you are able to observe your own inner machinery, your reactions, fears, attractions, and gently step out of the rut.”

So, my question is, as medicos, we’re constantly learning; every single thing in our syllabus, our disease protocols, all of it keeps continuously changing. So, how do we, as medicos, apply this concept of unlearning into our lives, sir?

Acharya Prashant: It's a great question to begin with. First of all, thank you, the institution, the management for very kindly arranging this interaction. Thank you so much, and thank you for your patience and for being here.

So, the question is wonderful: “As medicos, what’s the importance of unlearning?”

I think, in many ways and at many levels, the first thing is, you’ll be dealing with the patient. And you’ll be looking at that particular body, and the idea will be that the disease is contained in that particular body. And that idea is based on the assumption that the body is some kind of isolated or separate unit, and so we treat the body, and that we take as our responsibility. Here is the patient, here is this particular unit, by this particular name, of this particular age, and we are to treat it, heal it, restore health to it.

But is this person standing in front of the doctor as a body really an individual, an isolated unit? Really? If as a doctor my job is to protect and restore health, can I look just at the one individual called the patient? Or is the patient actually a representative of an entire society, an entire ecosystem? Is there really an individual fragment called the patient?

And if my job is to bring health, can I limit my responsibility then to just one patient? Because that’s what is tempting to think, I have to deal with this patient. But what if the patient’s health and sickness both depend on the wider environment and the larger ecosystem? Then can we limit our responsibility to one individual?

I mean fine, I might be treating the patient’s lungs, and I might tell myself, even congratulate myself on being a good doctor of the lungs. But what about the society that corrupts, pollutes the air to such an extent that it becomes very difficult to keep the lungs healthy?

As a doctor then, can I say that I deal with an individual, or must I have a wider responsibility? What would you call it? A pulmonary specialist, right? Can I really be a good doctor of the lungs, if I support a kind of ecosystem that pollutes the environment in the name of development or custom, if I remain indifferent to it even if I don’t support it?

So, one thing, if I’m a doctor, then probably I have to say that health is my responsibility in the holistic sense, not just one patient.

You see, coming to it from another side, such a big proportion of diseases, as we know, are psychosomatic, right? And the mind is a receiver and a radiator. It takes in, it processes, it radiates, transmits. Which basically means you cannot be healthy, even physically, if the environment, the society, the family, the nation, the beliefs we have, the goals we pursue, the very foundations of our culture, our religion, our concepts; if they are misplaced, then how can the body remain healthy?

I’ll continue to remain obsessed with the body, which is obviously my responsibility. The doctor has to look at the body. But what if the primary sickness of the body does not lie in the body? And the doctor says, “I’m a very good doctor because I treat the body very well.”

More and more, we are entering an era where our knowledge of this material thing called the body, will be very, very good, very enhanced. We’ll know about the material and its systems in very advanced ways, and yet we’ll find that we are not really successful in containing disease because we’ll be looking at the unit, not the whole. And the unit is not self-sufficient; the unit does not operate in a vacuum. The unit is vulnerable to everything that is happening outside of itself, every bit of everything that it interacts with.

So, as a doctor, can we limit our responsibility to the one particular body or to the set of few bodies that come to us for treatment? Or must we have, as I said, a wider responsibility? And that wider responsibility really does not stop anywhere. The clothes we purchase, the movies we watch, the food we consume, the vote we cast, even the teams we cheer for in sports; all those things come back to us because it’s all very interconnected.

What I’m asking you is, what if you are a very passionate supporter of a sportsperson who, in turn, promotes chewing tobacco? I’m asking you. And you might be a very fine doctor, but you are a very passionate supporter of an actor or, let’s say, a cricketer who endorses. And there need not necessarily be things that are harmful just to the body, like chewing tobacco or cigarettes. There can be things that are harmful to the mind, and the mind, in turn, will destroy the body.

But I could be a very good doctor, and yet I could be supporting a kind of lifestyle, or a sportsperson, or an actor, or a celebrity, or a millionaire, or a politician, or a religious leader who, in turn, is polluting the mental environment in a big way. Then can I say that I’m on the side of health? Can I say that? That’s one question.

So, that’s one thing that probably we need to unlearn, that the patient is one unit in a silo. Then the next thing probably we could think about.

Questioner: If I may, sir, what you have mentioned about supporting someone who supports tobacco or anything of that matter that harms health, I think that as a doctor, if I’m supporting somebody who is supporting harmful practices, that would be a question upon my personal ethics. And I think my professors have taught me better than that. I don’t think anybody here, or any of the doctors that I know for that matter, would be supporting something like that. I think that’s a matter of personal ethics.

And when it comes to treating, you were saying that not treating a single person as a unit. I mean ideally I wish I could treat a problem as a whole and look at a community as a whole, and address the entire health issues that are affecting or ailing a particular community. But it’s not very feasible in practical clinical practice, is my question. How could I apply that, sir?

Acharya Prashant: Before applying, you have to be aware. And awareness very spontaneously breeds application. Knowing becomes being, becomes doing. You’re asking about doing, how do I practically make it feasible, which is how do I do it? It will get done, probably, you are aware.

Yes, the example about chewing tobacco was simplistic. But then look at other things. You might be supporting a leader who is very, let’s say, pro-development, and in the name of development is slaughtering the environment, and that comes back to the doctor as all kinds of diseases. But still, you say, “No, this is very good for my country, so I support that particular leader.” What about that?

Or you could be supporting a kind of music that basically promotes consumption. It excites you, makes you go out, makes you binge on stuff, and you say, “I am a fan of this particular artist.” And what’s most of that particular art about? I’m considering a particular case, right? It excites the listener, the consumer of the art, into going out, making purchases of all kinds, stuffing himself up.

A very, very direct case in point: climate change. We know the kind of health crisis that is. We also know that it is anthropogenic. We know we have done it. As doctors, if we are to deal with public health, shouldn’t we be supremely conscious of everything that contributes to climate change? Or do we limit ourselves to one person or a particular community? I’m asking. And climate change is everything that we are. Climate change is our dream. Climate change is our emotions. Climate change is our parties.

Climate change is the old concept of the full nest, “If I have come to such an age, I must quickly marry and beget a few kids.” The biggest contributor to climate change is population.

Climate change is our dietary habits. After transport, energy, fossil fuels, that category, the biggest contributor to climate change is animal agriculture. So, climate change is everything that we are, and climate change is a health emergency. We know that, right?

So, as doctors, do I treat the victims of climate change or the causes of climate change? I’m asking. As doctors, do I address the victims of climate change or the causes of climate change? But if I am to address the causes of climate change, then I’ll have to come back to myself, because climate change is everything that probably I too represent.

So, that’s what we have to understand. The disease is not in a particular body. The disease is the whole thing itself. Yes, chewing tobacco is an example that you can counter. But then, are you also, for example, being sensitized to the fact that what we call the happy life, the good life, the successful life, is the biggest contributor to climate change?

Yes, the ones we worship as our celebrities, the millionaires and the billionaires, and now the trillionaires of the world; they are the biggest contributors to climate change. Are we being sensitized to that? And if we are not, you see, the ones that we hold in such high esteem, one flight of their private jet is equivalent to the thousands of years of emissions of the average Indian. As average Indians, you and I may emit for 1,000 years, and that will still be less than what that particular celebrity can emit on one flight of his jet. Right? Or one round of his yacht. And we’ll still say, “He is the one I really admire for being successful, being happy, having made the best out of his life.” Is that part of our curricula?

And that person we are admiring might actually be responsible for a grave health crisis, not just personal, not just Indian, but global. A global health crisis might be brewing because of the ones that we admire. Are we being sensitized to that? That’s it. So, it’s not just about chewing tobacco that you can counter. It’s about everything. Please understand.

The next thing that we could do well as thinking individuals, as intellectuals, we could do well to consider and question the very relationship between the patient and the doctor.

As doctors learning cutting-edge technology, it is very possible that a sense of control, a sense of doership creeps in, “I am someone who understands, and I am someone who can do something.” And that feels good, many times.

When you operate on someone and you are successful, it can go to the extent of almost feeling like God. And the patient and the patient’s relatives, they’ll come and touch your feet and say, “You are indeed bhagwan for us, you saved a life.” That’s where you have to ask yourself, who am I really, and what my relationship with that individual is? I understand the body, yes, but do I also understand myself? And if I don’t understand myself, then the knowledge that I have will become a lot of doership, will become a lot of ego. That’s why the more knowledge you gain of the world, of the material, of the body; it becomes equally important to have a lot of knowledge of yourself.

We just mentioned climate change. Where is it coming from? We know so much about the material world today that we can consume it, exploit it in whichever way we want. We have split the atom, tremendous energy is now available to us. We have penetrated the core of the earth, so much fossil fuel is available to us. We know how the world operates, the sensual world, this world, the world of material, we know how it operates. But we do not know how we operate. And therefore, we do not know what to do with our knowledge.

So, what do we do with our knowledge?

Today the world has more than 10,000 nuclear warheads, enough to destroy the earth ten times over. Technologically, economically, we are better off than ever before in the history of mankind. And also, we are closer to destruction than ever before in the history of mankind. And this destruction I’m talking of is all man-made. There could be a nuclear conflict, and there is the looming spectre of the climate catastrophe. We know of the Doomsday Clock. We know how it’s ticking and where we stand on that. So,

You will have knowledge, great knowledge, as doctors. But if the eye also doesn’t turn inwards, and if you do not look at your own mental processes: how the inner being operates? Then that knowledge will fall into the wrong hands.

Please, get it. Externally, we’ll be very, very knowledgeable, very developed, very powerful, and internally, we’ll be the same primitive caveman. Is that not the condition of the world today?

Have we been able to get rid of greed? No. But we have been able to get rid of hunger in a big way, yes. Some parts of the world still go to bed hungry, but we have been able to pull a lot of people out of poverty. So, we have been able to fight that. Polio, yes, we have been able to fight. Tetanus, we have been able to fight. TB, we have been able to fight. But have we been able to fight jealousy and ignorance? And greed and desire, have we been able to fight that?

And if we have not been able to understand how we operate, then all this knowledge that we accumulate, whether as medical professionals or as students of any other field, all this knowledge is in very, very unsafe hands. We’ll have nuclear energy, but that will not power cities, that will bring down cities. You can have nuclear energy lighting up a campus or a city, or you can have nuclear energy flattening Hiroshima or Nagasaki.

And what have we done?

Nuclear power, and not just nuclear power, nuclear waste today. There are so many countries that are destroying, for example, in Europe, they are deciding to shut down nuclear power plants. And the countries that say that we want to use nuclear energy for peaceful purposes, they are always under the scanner, because it’s a dual-use thing. What you call a peaceful use can become a strategic military use in no time. Think of Iran, and think of the entire reason for the conflict.

We do not know what to do with our knowledge because we do not have any knowledge of who we are. And that’s what we need to unlearn, that this is everything that we can look at, is the reality. Therefore, if I know all this, that which is seen, I’ll be good. No. You also need to know about the seer, not just the seen. Who is the one looking at everything? What are his processes?

Where does, for example, desire arise from? I want to have a clinic of my own. I want to be the best doctor in town. You know, doctors in some sense are also entrepreneurs. They are running businesses, are they not? See, I have a doctor in my family, so I know a bit of it. So again, that’s where the meaning of life, the question, Who am I? The very question of my central identity, those questions become very relevant. And if we do not address those questions, then it will remain all about having a lot of knowledge without knowing who the knower is.

Questioner: So, what you said about having a happy life and how our ambition is driving us to the destruction of the planet, which I totally agree with. Is it not possible for us to have ambition and self-realization, self-clarity at the same time?

I again went through your book (Truth Without Apology) and there was a quote that I found. It says, you had written that “you must clearly enquire to what extent all your worldly endeavors have actually nurtured your inner well-being.”

So, in the same sense, if I want my own practice, if I want to go into the corporate setup, if I want to move out of India and go to another country where doctors are paid better, does that come and hinder me in the way of my self-clarity? Can I not have both things at the same time? Am I wrong for having that?

Acharya Prashant: No, no, not at all. I’m glad you raised this. You see, ambition, dreams, desires; these are also forms of action, subtle actions. Action that has not yet become material, right? It’s a plan. You do not see it because it has not materialized in a tangible sense, but it has already occurred here, within. So, it is action.

No action in itself is good or bad, right or wrong. Whatever that classification is irrelevant. What matters is the center the particular action is coming from, the point your action is coming from. Ambition or action or desire, whatever you call it, or the plan, or wanting to go there, being that, having money, it can’t be called good, it can’t be called bad. Virtue, vice, none of these labels can be applied to it. It can’t be judged.

The only thing you have to ask yourself is, Where am I coming from?

Yes, killing is bad, you would say, especially as savers of life. You’re life-givers, right? Killing is bad. You want to save lives. And what’s the context of the Bhagavad Gita then? Arjun, get up and fight, and kill if needed. And those are not strangers in front of him. Shri Krishna is saying, fight down even your own kith and kin, your teachers, the gurus are there, the brothers are there, Pitamah is there, and if needed, kill them. In fact, Arjun is rebuked when he is hesitant.

So, no action can be absolutely right or absolutely wrong. It depends totally on whether or not you know what things are like. And what does that mean, very specifically? That means, what is that, who am I, and what is the relationship between the two of us? Once you are clear on that, then spontaneously the right action occurs. You don’t need to be guided then. You don’t need to be told. You don’t have to consult a manual of living. Is this classified as a do or a don’t? Is this permissible, or is this stopped? You won’t have to think of that.

So, collecting money can be a wonderful thing. Think of somebody like Madan Mohan Malaviya gathering funds to raise one of the greatest universities of that time, the BHU. And he was traveling all over the country. He came to Hyderabad and got a really fat sum from here. He came here just for the purpose of collecting money. Money can be a wonderful thing. The question is: do you know what to use it for?

Going abroad can be a wonderful thing. You said you want to go abroad. Swami Vivekananda did go abroad, did he not? 1893, Chicago, and we all celebrate that. Going abroad can be a wonderful thing. The question is: what is it within you that wants you to leave your shores? What is it within you?

Equally, the acts that we think of as necessarily benign or pious, good, even holy, might actually contain a lot of evil if those acts are coming from the wrong center or a center of ignorance or indifference. That which may look like a vile thing might actually be a great thing if it’s coming from the right place.

Anger can be a wonderful thing. That image we just talked of the Gita, the image of Shri Krishna rushing towards Bhishma with the chariot wheel as the weapon, it’s immortalized, and Shri Krishna is angry in that moment. Anger can be a great thing, provided anger is coming from the right point. And not being angry can be a very silly thing if your lack of anger is coming from the wrong center. From the right center, you could be angry, or desirous, or ambitious, and it’s all fine. From the wrong center, you could be angry, or not desirous, or not ambitious, or not angry, and it would all be very wrong. It all depends not on the deed but on the doer; not on the action but on the actor.

So, wonderful, fly away, but please be clear on why you want to fly away. And if you have clarity, then you will never have to look at somebody for sanction, for permission. And also, you’ll be unstoppable. When you have clarity, the entire world might want to prohibit you, stop you, and you’ll say, “No, I know what I’m doing, and therefore I’m unstoppable.”

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