The most celebrated picture of a doctor in English painting is a picture of a child who cannot see him. Luke Fildes’s The Doctor, first exhibited in 1891 and now in the Tate, shows a labourer’s cottage at the end of a long night. A small girl lies across two mismatched chairs pushed together to make a bed. A physician in a dark coat sits beside her, leaning forward, his chin on his hand, watching. Behind him, at the edge of the light, the father stands with a hand on the shoulder of the mother, whose head has gone down onto her arms at the table. A lamp still burns on the table; through the single window the first grey of morning is reaching the child’s face. Henry Tate commissioned the painting in 1890, and Fildes said he chose its subject to put on record the status of the doctor in his own time. He is generally thought to have drawn on his own loss. His first child, a son named Philip, died of typhoid fever on Christmas morning in 1877.
Look at where the eyes are. The doctor looks at the child. The father looks at the doctor. The mother cannot bring herself to look at anything. The viewer, standing where the painter stood, looks at all of them. The only person in the room who does not see the doctor is the patient. Her eyes are closed. Whatever authority the painting gives its central figure, his stillness, his patience, his refusal to leave before the crisis has turned, is authority as it appears to the adults who are waiting on his judgement. The child for whose sake all of it is happening is asleep, and so the image that has stood for more than a century as the portrait of the good physician was painted, quite literally, from the parents’ side of the room.
I begin with it because this essay asks a narrower and harder question than the painting does. What did a doctor’s authority look like to the child? Not to the frightened adult, and not to the physician I later became, but to a person three or four feet tall who could not read a diploma, did not know what a diagnosis was, and understood the encounter chiefly through what the grown-ups around him did.
The title promises portraits, and I should say once, plainly, what it will not deliver. This essay describes no particular doctor, visit or illness from my childhood in Amritsar, and it reconstructs no remembered scene. What it can do honestly is describe the kinds of medical authority a child growing up in Punjab in the decades before the internet was likely to meet, as history and as types; then ask what a child’s way of seeing makes of that authority, what adult knowledge adds to the picture, and what adult knowledge cannot recover.
A Map of Healers #
A child in a Punjabi city of that era lived inside a map of healing that the adults around him moved through without needing to name it. At one end stood the government hospital, large, crowded and public, with its wards and corridors and its queues that began before the doors opened. Amritsar’s government medical college had been founded at Lahore in 1864 and moved to the city in 1920, and its hospitals were the place where the serious and the poor tended to arrive, often at the same time. Near the middle of the map stood the doctor’s clinic in the bazaar: a room with a signboard over the door, the physician’s name and his degrees painted in two or three scripts, sometimes with more letters after the name than a child could count. Attached to many such rooms, behind a partition or a wooden counter, was the dispensary, and in the dispensary was the compounder.
For a child, the compounder, the doctor’s assistant who made up the prescriptions and often gave the injections, was frequently the one who did the thing that hurt; another essay gives him the attention his place in Indian medicine deserves.
Beyond the clinic lay older systems of medicine with their own figures of authority. The ਹਕੀਮ (hakīm) practised the Unani medicine that had come to the subcontinent with Persian and Arabic learning, and the ਵੈਦ (vaid) practised Ayurveda. In 1970 Parliament passed the Indian Medicine Central Council Act, which created a statutory council and a register for practitioners of Ayurveda, Siddha and Unani; the state, in other words, gave these traditions a formal standing of their own alongside the medicine taught in its colleges. In a child’s experience the distinction between the systems was often less important than the distinction between people: this one was spoken of with respect, that one with a shrug, and a third was consulted for one kind of trouble and never for another. Another essay on this site looks at the crowded field of advisers a Punjabi patient could consult, from the healer to the neighbour (see the essay on the patient’s chatbot); here the interest is narrower. It is in how a child learned which of these people counted.
One common saying in Urdu and Punjabi speech held a whole theory of medical authority in a few words: ਨੀਮ ਹਕੀਮ ਖ਼ਤਰਾ-ਏ-ਜਾਨ (nīm hakīm khatrā-e-jān), half a hakim is a danger to life. What interests me about the proverb is where it places the risk. It does not say that the healer is dangerous, or that the old medicine is dangerous. It says that partial knowledge, worn with full confidence, is the thing to fear. Children are not equipped to apply that test. They can see confidence. They cannot see whether it covers half a knowledge or the whole of one.
The Room Before the Diagnosis #
Imagine, purely as an illustration and not as anyone’s memory, a girl of seven taken by her mother to a doctor’s clinic in a city bazaar on a winter afternoon in the 1980s. Before anything medical happens to her, a great deal happens around her, and she notices nearly all of it.
She notices the waiting. There is a bench along a wall, and the bench has an order to it that no one announces and everyone obeys. Some people have come earlier than others; some are allowed to go in ahead of their turn, for reasons that are explained to her mother in a low voice or not explained at all. She notices that the adults speak more quietly here than they do in the street outside, and that her mother, who is the final authority on everything at home, has become someone who waits to be told. She notices the furniture. The doctor sits; the patients stand, or perch on a stool set at the side of a desk whose edge is level with her chin. She notices the smell of a place where things are cleaned with spirit, and the sounds from behind the counter, glass against glass, paper being folded. When it is her turn the questions are mostly asked over her head. How many days. Has she eaten. Is there fever at night. Her mother answers. Her part is to open her mouth, to breathe in and out when the cold disc of the stethoscope is set on her back, and to hold still.
None of this is a diagnosis, and none of it is a judgement of the doctor’s skill. It is the room as a child receives it: an arrangement of heights, voices, waiting and permissions. The child reads it with great accuracy as a picture of who holds power here. What she cannot read is anything that would tell her whether the power is being used well.
Psychologists have tried for decades to describe what children understand about illness itself, and the findings complicate any assumption that a child in such a room is simply ignorant. In 1980 Roger Bibace and Mary Walsh, writing in Pediatrics, set out six developmentally ordered categories in children’s explanations of illness, consistent with the three major stages of cognitive development that Jean Piaget had described. In broad terms, the youngest children explain illness by whatever is nearby or happens at the same time; somewhat older children, by contact with a person or thing; older ones again, by something getting into the body; and only later by processes inside the body, and finally by the interplay of body and mind. The authors did not offer the scheme as a curiosity. They said it could help paediatricians explain illness and offer reassurance in terms a child could actually use, and respond to how much control a child felt over what was happening.
Set that beside the imagined girl on the stool, and the room looks different. She is not blank. She has a theory, and it is the theory her age makes available: that the illness came from something near her, the cold wind, the other children, the food at a wedding, and that it will be undone by something done to her from outside, a bottle, a powder, a needle. The room confirms the theory in every particular. Nothing in it invites her to revise it, because nothing in it is addressed to her.
The caution has to be stated at once, because it runs through the rest of this essay. A child’s perception of the room is a real experience and a poor instrument of evaluation. A bare room and a brusque manner can conceal excellent medicine; a warm voice and a well-kept waiting area can conceal poor medicine. What the child sees is accurate as a picture of how authority was arranged. It is not evidence about whether that authority was deserved.
Authority Borrowed from Adults #
The clearest account I know of how medical authority reaches a child is a play in which the doctor is mostly offstage. Rabindranath Tagore wrote Dak Ghar, The Post Office, in 1912; the English translation by Devabrata Mukerjea appeared in 1914. Its hero is Amal, a sick boy adopted by a man named Madhav, and the action of the play is almost entirely the action of a child confined to a room. A physician has ordered that he must not be let out of doors, because the autumn sun and the damp are bad for him, and so Amal sits by a window and talks to whoever passes: a dairyman, a watchman, a flower girl, a gang of boys, an old man who pretends to be a fakir.
Early on, Amal asks his uncle why he cannot go out. Madhav replies that the doctor says it is bad for him. Then comes an exchange that holds, in four lines, the whole structure of a child’s relation to medical authority.
AMAL. How can the doctor know?
MADHAV. What a thing to say! The doctor can’t know and he reads such huge books!
Amal presses: does the doctor’s book-learning tell him everything? Of course, says Madhav; don’t you know?
The child has asked exactly the right question. It is the question at the root of all medicine: how does the physician know what he claims to know? The adult’s answer is not an answer. It is an expression of the adult’s own deference, and the evidence he offers for the doctor’s knowledge is the size of the doctor’s books. Tagore lets the scene be funny, and it is, but the comedy is exact. Amal’s access to the doctor runs entirely through Madhav. What the boy receives is not the doctor’s reasoning, or even the doctor’s instructions in the doctor’s words. He receives his uncle’s faith, and his uncle’s anxiety, which in this house are the same thing.
Piaget gave the developmental side of this a name. In The Moral Judgment of the Child, published in 1932, he described a stage at which young children treat rules as sacred and unchangeable because they come from adults whom the child respects, a respect that runs in one direction only; he called it unilateral respect, and contrasted it with the mutual respect that grows later among equals. A doctor’s authority, for a young child, is usually authority of this borrowed kind. It is legible in the parent’s lowered voice and folded hands. When the mother defers, the doctor is powerful. When a parent says afterward that the doctor did not know what he was talking about, the doctor shrinks, and the child’s next encounter begins from a different place.
The borrowed authority also came in two kinds, and a child could tell them apart long before she could name them. The doctor in the bazaar was usually known to the family by name. He had seen the grandparents; he asked after an uncle; his authority was personal, built up over years and lent to the child through a relationship she could watch. The government hospital worked differently. There the doctor was often a stranger, seen once, in a corridor full of other strangers, and his authority belonged less to him than to the building, the white coat and the register on the desk. A child brought to such a place learned a different lesson about medicine: that it could be powerful and anonymous at the same time, and that the adults she depended on were, in that building, as uncertain as she was. Both lessons were accurate. They described two arrangements of trust that medicine still offers, and that patients of every age still have to learn to read.
The household does more than lend the doctor its deference. It also supplies the child with a theory of what a good doctor is, and the theory is learned long before any knowledge that might correct it. George Eliot caught the English version of that theory in chapter 45 of Middlemarch, in the scene where the young doctor Lydgate’s refusal to dispense drugs offends a grocer’s household; another essay on this site, on what the village knew about illness, reads that scene closely. One line from it is enough here. The grocer’s wife, defending the medicines she takes before the busy days of the town fair, says that what keeps her up best “is the pink mixture, not the brown.” She has a theory of medical authority built on the only evidence she can inspect: what she was given, and its colour. A child in a Punjabi household of the period inherited a version of the same theory. A good doctor gave something. The bottle with its measured doses, the paper packets of powder, and above all the injection, were the visible proofs that something had been done. Whatever the child understood of illness, she understood that.
The theory is not foolish, and the reason matters. For most of history, and for most people still, the inside of a doctor’s judgement is invisible. What can be seen is the examination, the manner and the thing handed over at the end. A family that judges a practitioner by what it receives is using the evidence available to it, and its judgement is often roughly right: the doctor who examines carefully and prescribes thoughtfully will, over years, earn a better name than the one who does neither. But the theory has a blind spot exactly where judgement matters most. It cannot tell a well-chosen bottle from an unnecessary one, and it rewards the practitioner who gives something over the one who explains why nothing should be given.
Who Received the Explanation #
The Post Office has two physicians, and the difference between them is the difference this essay has been circling.
The first is the village doctor who confines Amal. In the play’s opening scene he speaks only to Madhav. He quotes the medical scriptures at him in verse, takes snuff, pronounces that the patient needs the most scrupulous care, and observes, when Madhav says the boy winces at the medicine, that the more the patient winces the surer the effect. In the second act he returns, asks Amal how he feels, and receives a cheerful answer: all the pain seems to have gone. Then, in a stage direction, he turns away from the child. “[Aside to MADHAV] Don’t quite like the look of that smile. Bad sign that, his feeling well!” The real conversation, the one about Amal, takes place a few feet from Amal and over his head. The doctor orders the front door locked against the draught, the window shut against the sunset, and leaves.
The second physician arrives at the end, sent by the King. His first words are a reversal of everything the first doctor commanded: “What’s this? How close it is here! Open wide all the doors and windows.” Then, touching the boy, he asks, “How do you feel, my child?” When he tries to send away the village headman, who has bullied Amal throughout the play, the child objects that the headman is his friend, and the State Physician gives way at once. “Very well, my child. He may remain if he is a friend of yours.” He is the only adult in the play who asks the child a question and then acts on the answer.
I do not want to make Tagore’s play into a manual of bedside manner. It is not one. The State Physician arrives with the King’s herald in the last minutes of a boy’s life, and the opening of the windows carries a meaning that has much more to do with release than with ventilation. Readers have long argued about what the King and his physician stand for. But the contrast Tagore draws is unmistakable, and it is a contrast between two answers to the question of who receives the explanation. The first doctor addresses the guardian and manages the child. The second addresses the child, and lets him decide something.
The ethics of paediatrics has been moving, slowly, from the first answer toward the second. In 1995 the American Academy of Pediatrics’ Committee on Bioethics published a statement that set out, for American practice, a framework in which parents give informed permission and the child, where able, gives assent: an agreement sought from the child in terms suited to the child’s development. In 2016 the Academy returned to the subject, and the technical report that accompanied its revised policy stated the principle plainly: as children mature, their own views should carry a growing share in the medical decisions made about them.
It would be unfair to measure the doctors of an earlier Punjab against American guidance written decades later. Speaking to the parent rather than the child was the ordinary practice of many places and many generations, and it had reasons: crowded clinics, short visits, the plain fact that the adult would carry out the instructions, and a culture in which children were not expected to be consulted about much. Those reasons have not vanished. But the gap between who was examined and who was told has a cost, and the child pays it. When no one explains, the child explains for herself, with the theory her age makes available, and her theory is often more frightening than the truth. The illness came from something she did. The needle is a punishment. The doctor turning aside to murmur to her mother means that something terrible has been found. A few sentences directed to her, in words she can hold, would not have changed the treatment. They might have changed what the treatment meant.
Objects Before Meanings #
Children meet medicine’s objects before they meet its ideas, and they give the objects meanings of their own.
The stethoscope, for a small child, is less an instrument than an insignia, the thing that distinguishes the doctor from every other adult, worn round the neck the way an official wears a badge (an essay on learning to use one describes the other side of that object). In clinics of that era the injection usually came from a glass syringe and a reusable steel needle, boiled in a small sterilising pan; the ritual of boiling, the steam, the tongs, lent the moment a solemnity that a sealed plastic packet does not. Liquid medicine came in a bottle with a strip of paper pasted down its side, cut or marked into doses, so that the level of the liquid recorded how far the treatment had got. Powders came in small folded paper packets, a ਪੁੜੀ (puṛī) each, to be unfolded at a set hour and emptied onto the tongue or into water. The prescription itself was a slip of paper covered in a handwriting the child could not read, and that the parents often could not read either, carried from the doctor’s desk to the compounder’s counter as though it were a sealed message.
Each of these objects carried a meaning for the child that was not the meaning it carried for the doctor. The doctor’s bottle was a dose; the child’s bottle was a measure of time, the stripe of paper telling her how many more days. The doctor’s stethoscope gathered sounds he would interpret; the child’s stethoscope was a cold circle and an instruction to breathe. And the doctor’s injection was a route by which a drug reached the blood, while the child’s injection was the climax of the visit, the event the whole afternoon had been arranged around, the thing she would tell her friends about.
Punjabi has a small accident of vocabulary that I find useful here. The word for an injection is ਟੀਕਾ (ṭīkā), and the same spelling names a commentary on a text, the kind of line-by-line exposition that scholars write to explain a difficult book. They are two different words that happen to coincide. In Hindi, where the same pair exists, one etymology traces the first to an older word for the mark left on the forehead by inoculation, a mark compared to the tilak, and the second to the Sanskrit ṭīkā, a commentary. The coincidence is etymologically meaningless and morally suggestive. The child of that era usually received the first kind of ṭīkā. The second kind, the explanation of what was being done and why, went to the adults, when it was given at all.
I am wary of the nostalgia that gathers round such objects, and should say why. The glass syringe looks beautiful in retrospect; a reusable needle is only as safe as the sterilisation behind it, and the history of medicine is not short of reasons to prefer the sealed packet. The bottle of mixture, recalled with affection, was in many cases a combination of ingredients that would not now be given together. And the prestige of the injection was not harmless. A remedy valued for its sting can be requested, and supplied, when it is not needed. The child’s sense that the needle was the real treatment and the advice was decoration was not only a child’s error. It was, often, the household’s error too, and sometimes the practitioner’s.
What the Physician Can Now See #
A physician looking back at medicine as a child met it can see things the child could not, and the temptation is to think that this settles the matter. It does not.
What training adds is structure. I can now see that the compounder was not a minor figure but the front line of a great deal of urban practice, the person who turned a doctor’s decision into an object in a patient’s hand and who, in the absence of other explanation, became its interpreter. I can see that the doctor who turned aside to speak to the mother was, in most cases, not being unkind; he was speaking to the person who would carry out the plan, in the limited minutes the bench outside allowed him.
What training cannot add is the content of any particular encounter. Looking back from a profession, it is tempting to reconstruct the illnesses of childhood and supply them with diagnoses: that fever was probably this, that cough was probably that, that bottle probably contained such and such. These reconstructions are worth very little. They are hindsight, assembled from present knowledge and fitted to fragments, and they have the dangerous property of feeling like memory once they are made. Another essay on this site, about Khalsa College in 1995, dwells on the way a finished life rewrites the record of an unfinished one; the same caution applies to the clinics of childhood. An adult cannot know what a doctor of that era was thinking, what he doubted, what he could not afford to order, what he had seen that morning that made him cautious or brisk. The child did not have access to any of that, and the adult who was once the child has no more access now. He has only a better vocabulary for guessing.
There is a second error waiting on the other side of the first. Having learned how much medicine has changed, the physician can look back at the dispensary and the hakim’s shop with a kind of condescension, as if the people who worked there were simply behind. Some were. Many were doing careful work with the means they had, in conditions that would test any practitioner now. The child’s view romanticises or fears; the adult’s view can patronise. Neither is the same as knowing.
Kindness and Competence #
A blunt question stands in the way of everything said so far. If a child’s view of medical authority is so limited, why attend to it at all? A child’s trust or fear is real, but it is a poor measure of a clinician. Children trust the doctor who gives sweets and dread the one who gives injections; neither preference tracks whether the right thing was done. Should the physician’s interest in the child’s perception not be confined to making visits less frightening, a matter of manner, while the substance of medicine goes on elsewhere?
The objection is right about measurement and wrong about meaning. It is true that the child’s impression cannot be used to grade the doctor. It is also true that four different things are tangled together in any encounter, and the child’s perspective is one of the few that shows how easily they are confused. There is warmth, the sense that the doctor regards the patient as a person. There is clarity, the degree to which the patient, or whoever is responsible for the patient, understands what is happening and what to do. There is technical skill, the correctness of the examination, the reasoning and the treatment. And there is outcome, which depends on skill but also on the disease, the patient, the circumstances and chance. None of these is a reliable proxy for any other. The warm doctor can be wrong; the curt one can be right; the skilled one can lose a patient; the careless one can be lucky.
Fildes’s painting is instructive here too, because its doctor is beloved for a reason that has partly to do with weakness. A commentary on the painting in the British Journal of General Practice noted that the doctor is watching for the crisis of the illness, the turning point that, before antibiotics, a physician could often do little to bring about, and observers have long noticed that Fildes left out the instruments a late-Victorian doctor would have carried, the stethoscope, the thermometer, the sphygmomanometer. The image of medical authority as patient presence was made at a moment when presence was much of what medicine had to offer. As treatments became powerful, authority moved into instruments, tests and procedures, and the child in a modern room is as likely to watch a screen as a face. The painting’s doctor is not more competent than his successors. He is more visible, because there is less between him and the child.
The proverb about the half-hakim and the grocer’s wife’s pink mixture make the same point from opposite directions. Confidence, which a child can see, is no guarantee of knowledge, which a child cannot. A bottle, which a household can count, is no guarantee of judgement, which it cannot. What the patient can inspect has always been easier to value than what the patient cannot, and every system of medical authority, the dispensary’s and the modern clinic’s alike, has been tempted to supply the inspectable thing in place of the rest. In the same chapter Eliot’s narrator remarks, drily, “let the wise be warned against too great readiness at explanation,” because it “multiplies the sources of mistake.” The warning is sometimes read as advice to say less. I read it as advice to fit the explanation to the hearer. Lydgate’s mistake was not that he explained; it was that he explained to a grocer as though the grocer were a colleague.
That is where the child’s perspective earns its place. It does not tell us whether the doctor was good. It tells us what the encounter meant to the person most affected by it, and whether anyone tried to make it mean something better than fear.
A Child in Today’s Room #
A family physician sees children, and children still come into rooms arranged around the adults who bring them. The furniture is lower now in some places and the walls are painted with animals, but the questions are still mostly asked of the parent, and the explanation is still mostly given to the person who will fill the prescription. Some of that is unavoidable. A toddler cannot weigh a treatment, and an adolescent’s privacy raises questions of its own. But between those ages lies a long stretch of childhood in which a few sentences addressed to the child are possible, and the omission of them is a choice.
A physician can take from the argument of this essay a few habits worth keeping, as intentions rather than as claims about anything accomplished. To speak to the child before touching the child, and to say what the touch is for. To give the second kind of ṭīkā along with the first: a short commentary, in words a child of that age can hold, on what is being done and why. To ask the child a question whose answer will actually be used, even if the question is only which arm, or whether the parent should stay. And when a child asks the question Amal asked, how can the doctor know, to treat it as the best question in the room rather than an impertinence, and to answer it honestly: because of what the chest sounded like, because of what the test showed, and sometimes, because I do not know yet and we will find out together (a subject another essay takes up at length).
None of this guarantees anything about competence, and the previous section explains why it should not be confused with competence. It concerns the other thing the encounter is: an event in a child’s life that she will interpret whether or not anyone helps her. The doctors of an earlier era, whatever their skills, mostly left that interpretation to the child and to the adults whose faces she watched. The objects did the rest. That was not cruelty. It was a habit, and habits can be changed.
If someone were to repaint Fildes’s picture from the bed, the composition would turn round. The parents would still be at the edge of the light, because they are always there. But the doctor’s face would be turned toward the patient’s open eyes, and the person being watched would be watching back. That is not a sentimental image. It is simply a picture in which the child can see who is responsible for her, and has been given enough of an explanation to ask, as Amal did, how he knows. The doctor’s books may be very large. The child is entitled to a better answer than their size.
Evidence and Editorial Note #
Documented findings. The essay relies on the author’s public biography: upbringing in Amritsar; training and practice as a family physician; Punjabi as his first language, with Hindi and Urdu. Luke Fildes’s The Doctor (first exhibited 1891; Tate), its commission by Henry Tate in 1890, Fildes’s stated aim to record the status of the doctor, the death of his son Philip from typhoid on Christmas morning 1877, and the absence of stethoscope, thermometer and sphygmomanometer from the picture: Wikipedia, “The Doctor (painting)”, and Jane Moore, “What Sir Luke Fildes’ 1887 painting The Doctor can teach us about the practice of medicine today,” British Journal of General Practice 58(548), 2008, 210–213 (PMC2249807), which also describes the composition and the illness’s “crisis” before antibiotics (the article dates the work to 1887; the Tate and most accounts give 1891 for its exhibition). Government Medical College, Amritsar, founded at Lahore in 1864 and moved to Amritsar in 1920: Wikipedia, “Government Medical College, Amritsar”. The Indian Medicine Central Council Act, 1970, and the Central Council of Indian Medicine for Ayurveda, Siddha and Unani: Wikipedia, “Central Council of Indian Medicine”. Roger Bibace and Mary E. Walsh, “Development of children’s concepts of illness,” Pediatrics 66(6), 1980, 912–917 (PubMed 7454481; six developmentally ordered categories consistent with Piaget’s stages, offered to help paediatricians explain illness, reassure and respond to the child’s sense of control); the summary of the sequence of categories is standard reference knowledge of that scheme. Rabindranath Tagore, The Post Office (Dak Ghar, 1912), English translation by Devabrata Mukerjea (Macmillan, 1914; the name is spelled Mukherjee in the Project Gutenberg edition, eBook 6523), from which the quoted exchanges and stage directions are taken; date of the Bengali play: Wikipedia, “The Post Office (play)”. George Eliot, Middlemarch, chapter 45 (Project Gutenberg eBook 145), quoted for Mrs Mawmsey’s “pink mixture” and the narrator’s remark on explanation. Jean Piaget, The Moral Judgment of the Child (1932), unilateral and mutual respect: standard reference knowledge, paraphrased. American Academy of Pediatrics, Committee on Bioethics, “Informed consent, parental permission, and assent in pediatric practice,” Pediatrics 95(2), 1995, 314–317 (PubMed 7838658); A. L. Katz, S. A. Webb and Committee on Bioethics, “Informed Consent in Decision-Making in Pediatric Practice,” Pediatrics 138(2), 2016, e20161485 (PubMed 27456510), whose abstract states the principle of increasing inclusion of the child’s opinion, paraphrased here. Hindi टीका as two words, one traced to a forehead inoculation mark compared to the tilak and one from Sanskrit ṭīkā (commentary): Wiktionary, “टीका”; the parallel Punjabi usage of ਟੀਕਾ, the proverb ਨੀਮ ਹਕੀਮ ਖ਼ਤਰਾ-ਏ-ਜਾਨ, ਪੁੜੀ for a folded paper packet, and the role of the compounder in Indian English are stated as general usage and standard reference knowledge. Descriptions of clinic furnishings, glass syringes, sterilising pans and dose-marked bottles describe the era in general terms, not any particular clinic. Vendor representations. None.
Recollection and tradition. That the author grew up in Amritsar is biography. The essay describes no doctor, visit, illness, treatment, relative or room from his childhood and asserts no remembered scene; it describes types of practitioners and objects of the era as history. The girl of seven in a bazaar clinic is a hypothetical figure, introduced as such, and describes no real person. Unani and Ayurvedic practice are named as traditions, without claims about their efficacy.
Analysis and forecast. The reading of Fildes’s painting from the child’s position, the interpretation of The Post Office and Middlemarch, the use of the two senses of ਟੀਕਾ, the distinction among warmth, clarity, skill and outcome, and the habits described in the final section are the author’s interpretation and ethical intention as of November 6, 2026, not a claim about results achieved. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.