The philosopher Michel Foucault is well known to researchers and readers in several fields, especially sociology, anthropology, history and philosophy. Many of his writings also dabble in another discipline – modern biomedicine – though most doctors, nurses and other healthcare practitioners are hardly aware of him. To be sure, one can very well understand the theories and practice of medicine without ever reading a single word of Foucault. But if one desires to understand the cultural and philosophical aspects of medicine in modern times, then his writings and concepts prove extremely helpful.Foucault’s most commonly known idea in medicine, the “medical gaze” or the “clinical gaze,” is one that pertains to how practitioners think during a clinical interaction. He introduced it in 1963 in the book Naissance de la Clinique which later was translated into English as The Birth of the Clinic: An Archaeology of Medical Perception. Foucault argued that beginning about the late 1700s, there occurred a revolutionary shift in how medical practitioners in parts of Europe imagined the human body and human diseases, and the shift was catalysed, among other things, by the newly influential sciences of anatomy and pathology. Foucault gave the name “medical gaze” to the resulting novel perspectives, which over time became dominant in biomedicine across the world.But before we delve into the new, let’s quickly look at what the old was in this context.Wherever human societies lived in the past, there existed healing traditions. Every such tradition had its concepts and beliefs about what the human body was, what was contained within, how it all worked, and how it stopped working to give rise to ailments. These different knowledge-systems and practices also had many similarities. For example, the idea of the influence of “evil spirits” or the theory of an imbalance in the body’s “vital elements” were concepts common to multiple cultures and regions.Let’s take the example of a physician in the 1300s seeing an ill person who is coughing uncontrollably. How might they have approached the person? Just to take a sampling of the causes of ill health enumerated in the book The Roots of Ayurveda (author Dominik Wujastyk), below are some causes of the cough that a random physician in South Asia from the premodern period might have considered:the ill person has been consuming an inappropriate diet;the person’s diet is out of sync with the weather;there is an abnormal collection in the person’s chest of one of the body’s vital elements/humors;the person heard extremely bad news or saw something horrible;the person accidentally consumed something poisonous or was deliberately fed a harmful substance.Of course this mental train of thought would have occurred if the healer went strictly by the medical texts of the time. But in practice, there were many variations from the text, minor and major, on the ground. There were also many practitioners from non-elite backgrounds who would never have known such texts. But a clear message to take home from this list of disease causes is that in the past, people – practitioners and patients alike – rarely considered disease to be localised. That is, dominant medical thought rarely said anything about the lungs in the case of a coughing individual, or about the kidney or the bladder for someone with urinary issues. Organs and tissues, ubiquitous today in how we imagine normal and abnormal bodies, rarely featured in the medical consultations of the past. Instead, the human body was considered to be a single interconnected whole in a constant give and take with its surrounding environment, with disease said to occur when something altered the well-maintained balance of the “humors” or “vital elements” in the body.What would a modern physician today (including, in fact, many college-trained Ayurvedic doctors) think when they come across an ailing person coughing uncontrollably? They might remember the whitish-yellowish lung tissue they saw in their training during an autopsy or in a pathology specimen. They might recall the “cavities” they saw on a chest X-ray. They might mentally list the names of the different bacteria and viruses which can potentially infect lungs.This more focused, localised way of thinking about disease and ill health is what, broadly speaking, Foucault labelled the medical gaze. That is, on simply hearing the patient talk about their problems, the cognitive gaze of the physician bypasses the person in front of them, reduces them to a patient in possession of an anatomical body, penetrates that body, and begins evaluating the possibilities of abnormalities in tissues and organs inside. Earlier, practitioners did not consider their patients to be a collection of discrete tissues and organs each with its own independent pathology and disease. Indeed the gaze of the healer began at the body – as a whole – and ended in the heavens, traversing such elements as meals, family, community and climate in between, while the new medical gaze began as far down as at the level of the tissue. In other words, Foucault says that in parts of Europe “over the course of the 18th century, the question the doctor asked the patient was transformed from ‘What is the matter with you?’ to ‘Where does it hurt?’”So when we lament today that biomedical doctors – and indeed many AYUSH doctors too – are little interested in listening to us and in spending time with us, we are in a way mourning this shift wherein medical practice began to be less about empathetic conversations, stories, feelings and symptoms, and more about abstract disease concepts, abstruse terminologies and mechanical tests. We are also mourning the fact that doctors have largely turned away from their patients and turned towards images, test reports, case files and computers. To be sure, we benefited substantially from these changes, and very few of us, if at all, would like to live in a world in which modern healthcare doesn’t exist. But – as we have known for decades now – we have certainly lost many of the fundamental, human aspects of the medical encounter.Of course people, including healthcare practitioners themselves, did not need Foucault to tell them about these shifts in the nature of the patient-practitioner interaction. Since at least the early 1900s, progressive medical educators and doctors across the world have been speaking about these changes and attempting to reinsert humanistic perspectives into medical education and training. For example, in Bombay in the 1940s, the Dean of G.S. Medical College spoke with the audience of All India Radio about how medicine had “become more specialised and more technical… More and more accurate assessments of pathology with the help of more and more colleagues and instruments and less and less intimate understanding of the patient as a whole, as a person with a home and anxieties and economic problems, has become the order of the day.”It is important, however, to not romanticise the past. Any discussion of the fallacies of modern biomedicine – of which there are many – generally tends to metamorphose into appeals to revert back to an almost mythical past when healthcare practice and the patient-doctor interaction were supposed to be invariably better, even perfect. Such claims are untenable. Even if practitioners in the past were not obsessed with the “reductionism” of modern times – reducing a person to simply organs, tissues, MRI scans, etc., – that doesn’t imply that they were, as a rule, more humane than practitioners today. After all, much of what happens in medicine and healthcare is a reflection of the state of affairs in the larger society and polity. For the Indian context, an example from the mid-1800s will suffice. In 1855 a Dalit girl, Mukta Salve – a student of Savitribai Phule and Jotirao Phule – rhetorically asked in an essay: “These people drove us, the poor mangs, and mahars, away from our own lands, which they occupied to build large buildings… When our women give birth to babies, they do not have even a roof over their heads… If they get some disease while giving birth, where will they get money for the doctor or medicines? Was there ever any doctor among you [Brahmans] who was human enough to treat such people free of cost?”Instead of putting all our health reform eggs in the basket of a purported golden age of the past, it might be more helpful to focus on the present and keep reiterating that doctors need to think of their patients as persons and as individual wholes. Going a step further, they also need to consider people as an inseparable part of society and of the society’s structures and institutions. Structural inequalities and systemic oppression, for example, are hugely important causes of disease and ill health, but often do not appear in the gaze of many practitioners. One of the lasting lessons I learned practising in India where tuberculosis still dominates, is that while anti-TB medicines (which work on microbes within lung tissues, following the “medical gaze”) are central in the recovery of a TB-afflicted person, a simplistic reliance on medicines without making sure that patients are eating well, able to stay reasonably healthy, etc., will only take us so far. Besides, TB is an eminently preventable disease: that it still rages in some countries of the world and not others, and mostly appears among socioeconomically marginalised communities and not others, tells us that contemporary TB prevalence has more to do with society and politics than with medicine and biology.In other words the medical gaze, while hugely effective in clinical care, does little to actually make a patient feel cared for, and is frequently counterproductive when applied without thought in healthcare policymaking.Kiran Kumbhar is a historian, teacher and former physician, currently affiliated with the University of Pennsylvania.In his column ‘Past Forward’, Kumbhar provides us with a rear-view mirror that ensures we drive straight ahead.