Before antibiotics came to the rescue, our job as physicians was mainly custodial: we tried to take good care of patients and provided them with love and sympathy. Whether the patient survived or not depended on the natural history of the disease.
Our Nepali patients knew this all too well. For example, typhoid fever was called "myadhe joro" (fever with a limited time span). Generally the fever lasted for three weeks and if you survived 20 to 25 days with fever, then you would be fine.
Physicians' lotions, potions, and pills made little difference. American physician, Lewis Thomas observed in 1937 that if being in a hospital bed made a difference it was mostly the difference produced by warmth, shelter, and food. But when antibiotics became widely available starting from the 1940s and 50s, methods of treatment changed forever.
There are now effective prevention and treatment measures for many infections and non- infectious illnesses. We have moved beyond treatment in a big way into the realm of evidence-based medicine. Many hospitals in the west especially in the United States are now run by administrators and nurses at various levels who make sure doctors follow rules and regulations set by the administration so that infection is under control.
For example in many US hospitals there are random camera monitors to ensure doctors follow rules (like wearing masks and head covers) while performing even minor procedures on patients so that infections are prevented. Even senior doctors are reprimanded if they are found disobeying these rules. Naturally many senior doctors have not been able to adapt well to these changes.
In addition, many doctors in the west are experiencing insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and fellow doctors bearing tattoos and thinking nothing of their behaviour.
By comparison, we Nepali physicians have it easy. We don't have to fill out long forms after every visit nor do we have to worry too much about malpractice litigation, although Nepali lawyers are clearly lurking in the background.
But surely we Nepali physicians have to ask ourselves if we are always working in the best interests of our patients (when we don't follow simple guidelines like washing hands with soap and water), even if in the US and other developed countries seemingly unnecessary hassles may be interfering with patient care.