Like other facets of life medicine has undergone a sea change. No longer are hospitals managed by doctors and medical administrators but they are run by professional managers, marketing people, ad men and accountants. Because health sells, it has attracted birds of many feathers. Self praise, broad casting available facilities, and slogan mongering is no longer taboo. Even the new breed of consultants is different. General physicians and surgeons are becoming rare. System specialist, vertical specialist and organ specialist are now replacing them. The principle is to know, more and more of less and less. The new consultant is a young upwardly mobile person (yuppy). He wears designer clothes, uses the latest deodorant, cologne, has well coffiured hair and manicured nails. He drives a City Honda or Sonata and is highly lab oriented rather than patient oriented. Some of them come from private medical colleges and sincerely believe that monies spent in their education must be recovered at the earliest. Many of them have personal management and marketing experts, and believe in taking the help of pharmaceutical companies who not only arrange CME and their lectures but also their personal trips.

They may be spending little time in medical libraries and lots of time in personal gymnasium, clubs and the cocktail circuit. Attachments to several hospitals leaves him little time for hobbies. Family holidays are encouraged by pharmaceutical companies who are not averse to even paying the bill.

The modern consultant is a study in contrast from his teachers. He will remember that they wore white aprons during grand rounds and emphasized bed side manner and group discussions. It was taught that clinical diagnosis must be made on clinical findings and only relevant investigations must be ordered. They always had the time to visit the library and pour over medical journals. Social life revolved around medical association dinners and personal hobbies.

I wonder what the future beholds? As telemedicine progresses conferencing with colleagues over long distances will be possible. With Robotic surgery coming up, surgeons will be pressing a button on carousels rather than holding a knife. Even long distance surgery will be possible. Medical curricula will have to change. Computers, electronics and biomedicine will have to be included. Some medical procedures like angioplasty’s and therapeutic embolisation will come in the domain of technicians.

In this scenario, the patients state of mind can be gauged from this story from the ‘New York Times’. A reader asks a question to the editor “My cold is not going from the last one month. Will I see a family doctor, an ENT, pulmonologist, allergist or biomedical engineer?” The equally befuddled editor replies “I will let you know”.

Wonder what future consultants will be like?