Sunday, January 3, 2010

Ethics Take a back Seat

Ethics take a back seat, as opportunism goes into overdrive & leads from the front

About the Medical Profession......

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Image credit : Shyam's Imagination Library

Once upon a time considered the noblest profession, but now....

Before I proceed with the post let me make a point clear. I am among the millions who have made a living out of this profession for better part of the career. I was in the pharmaceutical industry and whatever success I achieved, was on account of support I received from this profession. So, what I speak is more out of pain rather than disrespect for this profession. I know, even the members of the medical profession will agree, that it is no longer as noble as it used to be a few decades ago. The profession still has its ethics; the members very religiously follow them. The flame for service and charity, burning inside every member of the profession, has only dimmed a bit, but not extinguished completely. The ethics, I repeat, are still there, but that the parameters to evaluate them have diluted considerably over the decades, is something even the medical profession will admit to.

Before we get into the “why”&; “how” part, let us examine what the ethics are.

Hippocratic Oath

Hippocrates the father of Greek medicine in 5th century BC laid down certain principles and practices for the graduating medical professionals. Most of which are still relevant in the present day context. The same was documented by his followers in 4th century BC and is known as Hippocratic Oath. The oath has undergone changes with the passage of time. Now most of the medical institutions impart their own revised version of the oath, but the essence of the original version is retained.

 The important aspects being,

"To practice and prescribe to be the best of my ability for the good of my patients and to try to avoid harming them"

"Never to avoid deliberate harm to anyone for anyone else's interest and to avoid violating morals of the community.”

"To avoid doing things that other specialist can do better."

apart from this,There are the international conventions like the Helsinki and Geneva conventions that bind the medical profession to the ethics. We also have the Jonathan J king’s suggested good practices for the medical profession. Three weeks before his death, Jonathan King defined the key messages he wished to bring to the attention of the medical community through these lectures.
Some of them are,

The patient is your client and should be treated with respect. Seek out and give full weight to your patient’s suggestions and opinions on treatments. Never, ever treat your patient as an object or as a second class citizen.

Empathize. Put yourself in your patient’s shoes as much as you can, recognizing that a
fatal or harsh diagnosis separates the patient from “ordinary” people.

Foster the patient’s feelings of control and hope, however small they appear scientifically.

Base this on a foundation of honesty. In other words, tell the whole truth from the start, but don’t fear or disparage your patient’s drive for alternatives; help assure they are sensible.

Help and urge the patient to build a support system. Urge the patient to bring a companion to office visits and other important events.

Encourage the patient to consult other sources of information (including other doctors) and always make medical records available.

Expect patients with a poor prognosis to alternate between “frantic” search for solutions followed by calm commitment to a plan. Be patient when your patient is frantic.

Make every extra positive gesture. They boost morale enormously and ease the feeling of being alone. Thoughtless comments rankle, and are likewise magnified.

Make physical surroundings and institutional arrangements — lighting, food, etc. — as pleasant as possible.

Support efforts to speed up attempts to apply promising but unproven treatments for patients with a fatal diagnosis.

Similarly codes of ethics are prescribed in all the schools of medicine and religions. Similarly Ayurveda is considered to be one of 64 forms of arts and forms of worshiping god and reaching him.

Nowadays, since medical malpractices are recurring &; increasing everyday, a reminder of this oath should be made to everyone on the medical industry. It is very important for them to realize the real essence of the oath of a medical doctor so that they can efficiently do what is expected from them.

What is ethical? And what is not? 

It Depends on whether you are part of the medical profession or a part of the paying public. A doctor prescribing on the basis of inferences drawn out of assumptions and patient feedback is considered perfectly alright in a layman point of view but unethical from medical point of view. Similarly a doctor’s excessive dependence on diagnostics for determining the cause and cure is correct from professional viewpoint, but unethical from people view point. But if the expenses are borne by the insurance companies, the gulf between the two viewpoints narrows down considerably.
The entry of the corporates into the healthcare sector has made matters worse from the ethics point view. Service motto, benevolence is relevant only if it can support the ROI. I am not elaborating on the monetary aspect, or the aspects related to pharmaceutical industry that have more than contributed to this downward slide, because there is no point in telling people, things they already know.

Because of all these if  the medical profession  is  experiencing a loss of esteem among people. then you know who is responsible.

Naturally ethics take a back seat, because, it is the opportunism that gets into overdrive and leads from the front.

Best wishes,

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