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Ethics only way out of crisis in medical practice

Ethics only way out of crisis in medical practice

There are three basic principles of medical ethics: autonomy; beneficence; and non-malfeasance. Being ethical simply means respecting your patient’s ability to make his own decisions for them; making sure that what you do helps your patients; and do no harm to them. It all boils down to the golden rule – treat your patients the way you would like to be treated yourself!

With the decline in ethical values, society no longer holds the medical profession in the high esteem it used to in the past. Most doctors are alleged to follow unethical practices and that ethical standards in the profession are deteriorating, if you go by media reports. What can we do about it? Can talking about ethics lead to improvement? Yes, if reading about sports is to make one into an athlete.

When youngsters joined medical college in order to become doctors, they usually do it because they have idealistic goals and wanted to serve the community in general and patients in particular. One would expect that by the time they become doctors, after going through five and half years of medical college and three years of residency, they will have thoroughly imbibed these ideals from their seniors. Not really! The idealistic students seem to become hardened and cynical by the time they enter medical practice. Money game seems to afflict them due to various pressures, more than their own greed. There are several reasons for the doctors to get disenchanted from their avowed objectives viz. country’s laws, apathy towards the doctors needs by the society and rampant corruption and money making by other professionals. Doctors as a class are among the poorest even after the so called ‘cuts income’ and putting in work round the clock.

In good olden days, students needed to have a have a vocational aptitude before they considered going in for medicine. In the past, factors like whether you were interested in human welfare and how you behaved with others was an important criterion in selecting medical students. Not anymore!   High marks, high expectations of money, high earning teachers as role model and return on investment are some of the issues that come fore.  What is also happening is that there are now a large number of youngsters in other professions who earn huge incomes very fast! Why not doctors? Many doctors feel that they are overworked and underpaid; and that society owes them money because they work so hard, so patients should not grudge them their fees. Society should accept that they are professionals to help the patients and not guarantors of cure. They deserve the respect as helpful professionals.

The fact is that despite the temptations and pressures, most doctors do not stoop to any kind of malpractice, they are absolutely straight. Most doctors don’t practice, with the intention of being crooked. However as they face hardships in practice and get fleeced for every little work, they start on downward spiral. There is a need to develop some means of identifying honest and upright doctors who are competent and skilled, and then publicize these names, so that they are available to all patients. The list need not be comprehensive in the beginning, but once it becomes an established practice, doctors will start clamoring to be evaluated, so that they can get on to the list!

While most doctors are aware of some unethical practices and corruption indulged in the medical profession by a few, most prefer keeping quiet about this. Society generally perceives that doctors engage in a conspiracy of silence and secrecy – and most doctors refuse to stick their necks out by identifying “bad” doctors. While most doctors are worried about the skeletons in their own cupboards, if any doctor wants to improve the system, he needs to have the guts to stick his neck out. He may get ostracized by his colleagues in the process, but there is really no other option if we need to set our own house in order.

Unfortunately, the entire medical system has been labeled as morally bankrupt. Large corporate hospitals indulge in malpractice by pressuring their staff/ doctors to admit a minimum number of patients and perform maximum surgeries or tests, as well as to generate a certain amount of revenue. It is a sad reality that these hospitals are profit-making bodies, and their primary concern is going to be their bottom-line of revenue generation. However, they cannot function without doctors on their staff, and doctors could get together to resist these pressure tactics. Unfortunately, doctors are often so embroiled in petty politics, that they cannot join hands to look after their own interests. As a class doctors are considered as timid and lack a macro vision to see national interest. Many a times their false ego is responsible for their down fall.

The pharmaceutical industry and equipment majors are guilty of shoddy ethical behavior. They aggressively push their products, and entice doctors to prescribe the latest and most expensive “me-too” pill – irrespective of whether or not it is in the patient’s best interests. This is true of the medical equipment industry as well, which wants doctors to buy the latest and newest (and most expensive) scanner. This means that doctors then get pressurized into scanning large numbers of patients daily, whether or not their patients need these scans, in order to make their investment cost-effective. Some rich and powerful patients and their attendants force the hospital to plunder scarce and valuable resources on terminally ill patients. A major responsibility of a good doctor is to act as a gatekeeper of medical resources, so that he uses them wisely and efficiently for his patients and not allow any misuse, including himself.

 

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