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Doctor, doctor, can’t you see I’m a-hurting

Published: 12 October 2014

Among the most important dictums of modern medicine that must remain unchanged would be that the role of a doctor is ‘to heal sometimes, to comfort always but never to harm’.

MARCUS Cicero, a Roman philosopher, once said, “In nothing do men more nearly approach the gods, than in giving health to men.”

Though this is no longer true in the modern era, doctors are still held in high esteem by the public, based on results of recent surveys, especially with regards to the issue of trust.

Among the most important dictums of modern medicine, which must remain unchanged, is that the role of a doctor is “to heal sometimes, to comfort always but never to harm” (Sir William Osler).

This has to remain as the unwritten social contract of medicine, whereby the patient’s welfare comes first and all other things are secondary.

A doctor-patient engagement guided by this basic principle of medicine and practised within the Code of Professional Conduct of the Malaysian Medical Council is the prerequisite for an ideal therapeutic outcome for the patient.

However, even good doctors are mere humans, and as such will not be perfect. Sadly, mistakes will occur and doctors must be committed to learn from them and to minimize recurrence.

Personal suffering and damage resulting from such mistakes are often difficult to forget and to forgive. That is something that the doctor will have to live with.

This basic social contract of the patient-doctor relationship itself is now under re-examination. With the easy availability of medical information on the Internet, patients are now more informed. Unfortunately, many are also becoming more misinformed.

Doctors are seeing increasing cases of wrong self-diagnosis and adverse effects of wrong self-medication. A doctor’s good advice can easily get clouded when the patient is bombarded with too much unprocessed raw data and information.

Detractors paint doctors as money-making machines, rather than those who care for the wellbeing of the community. Unfortunate cases of medical errors and malpractice are often used for “doctor-bashing” in the media.

As responsible professionals, we do not condone the black sheep in our fraternity who overcharge and exploit patients for monetary gain. The social contract and not the commercial contract of medicine must prevail for every doctor-patient encounter.

The commercialisation of medicine affects both doctors and patients.

In addition, the profession is also besieged with many challenges, ranging from over-production by medical schools, falling quality of medical graduates, increasing medico-legal litigation, and increasing laws and regulations micro-managing medical practice.

Doctors, both young and old, are indeed feeling that there is a need to relook and reinvent medical practice to suit the changing times. Many are asking whether the social contract of medicine is an absurdity in today’s world of commercial medicine.

Doctors’ Day

Around the world, this special day is celebrated on different dates in different countries.

In the United States, the history of Doctors’ Day dates back to the 1800s when Dr Crawford W. Long became the first physician to successfully use anaesthesia in an operation on March 30, 1842. This unprecedented event is commemorated as their National Doctors Day.

Oct 10, 2014, was our first ever Doctors’ Day in Malaysia.

Our Doctors’ Day story is quite different. The Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) chose the date as the figure 10 represents perfection, i.e. 10 out of 10.

Perfection, whenever possible, is what we as doctors should aim for. As doctors, we must be committed to give our “10-10” each and every time we practise our skills. Patients expect this of their doctors. In return, we owe this duty to our patients.

With all the trials and tribulations the profession is going through, the Federation has decided that it is time doctors, their families and their patients take time to reflect on what was and should be the ideal doctor-patient relationship today and for the future.

Being a doctor is not just a job; it is a challenging commitment to serve. Aside from this, doctors have to deal with the reality that even a small professional mistake could drastically affect a patient’s life, as well as his own.

The oversupply of medical graduates is now a confirmed reality in Malaysia.

We can expect more than 5,000 medical graduates yearly as our 34 medical schools go into full production. Along with this issue is the perennial concern regarding quality, lack of proper training and an uncertain career future for the new doctors.

All this augurs badly for the future of medical graduates, doctors and patients. The uncertainty of their future will affect recruitment patterns into medical schools and will eventually lead to a shortage in years to come.

The commercialisation of medical education is already in full swing. It will have to go through the usual pattern of boom and bust. There will be many tales of tears and regret.

The public will have to reflect on this and impress upon policymakers and legislators that check and balances need to be put in place to ensure that we will have doctors in sufficient quantity, as well as quality, in the future.

The trend of rising cost of healthcare seems unstoppable. Patients, the public and even doctors themselves are seriously alarmed.

Again, the blame falls on doctors. The knee-jerk response of policymakers and legislators has been to call for more laws and regulations to regulate the business of medicine.

The reality today is that the business of medicine is in the hands of big corporations, not doctors. To businessmen, healthcare is a tradeable commodity. Its production and delivery is entirely a business process.

Each and every activity has a cost and needs to be accounted for with a profit. The businessmen’s concerns are returns-on-investments, dividends and share price. This has to be reflected in the standard operating procedures and performance of doctors, and the profitability of the industry.

Sadly, doctors are merely one member of the labour force for this industry.

Their professional fees are already regulated and capped by law. In absolute terms, the increase in doctors’ fees has been less than 1% per annum since 2000 and cannot account for the phenomenal rise in the cost of healthcare.

It is thus timely that patients, the public and doctors reflect on how to lobby collectively and on the right platforms to make their grievances felt.

Healthcare is not just a commodity to be traded. It is a basic right of each and every citizen.

The Federation is of the opinion that is timely to have a broad-based National Healthcare Council to study these proposed reforms. Members should comprise of key opinion leaders from all walks of life.

We can accept that there are inherent weaknesses in our existing system and fixing what is broken seems to be a more sensible approach to healthcare reform.

> Dr Steven Chow is president of FPMPAM.

Originally published in thestar.com.my
http://www.thestar.com.my/Lifestyle/Health/2014/10/12/Doctor-doctor-cant-you-see-Im-ahurting/

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