physician21

about medical tacts and talents

Archive for the category “medical ethics and bioethics”

Truth cheers

You are sincere, honest and truthful? But how can these good and gold qualities bring their generous harvest in our tricky and intricate life? Should truth be such bitter and shocking? Is it always so?

These questions are relevant to medical ethics and medical care. The physician should be well trained how to convey relief  and positive thinking to the patients through telling the truth in the proper manner. It is a fact that truth is rescuer and protector. The question is how to express truth that help loosen the situation and not the reverse. For example, one need not to tell the patient that there are no enough facilities (which can be almost always true) while only direct reassurance that the case need only available service is all that is needed.

There should be a way to tell the truth without making it typically bitter but rather to bring such ‘badly needed’ truth cheers.

Physician and physical contact

In the medical field ‘physical contact’ usually implies the medically required contact with patients and its aspect of disease communicability. However, this generally perceived view may need some reform to emphasize the two opposite sides, the profits and the risks. Although modern tools of communication could be of great help, they are used only in cases where direct contact of the doctor with patient is instantly not manageable. What kind of blesses a skilful physician can have in his/her attendance! The look; the affection; the touch; the wisdom and the proof. This may refer to the true start of the medical care from mind and not matter, from tact but not tempt, from thoughtfulness and not automaticity. Some people can argue metaphysical working in even lay and plain dealings and for them the medical cases wouldn’t be exceptions. The medical tactfulness can be gained in steps and over time. It comprises emotional, behavioral, ethical and medical progresses. In my opinion, the value of the clever physician lies in the lengthy and subjective path to acquire such collegial attitude and not only the cost and difficulty of the academic courses. Should the physician’s responsible physical contact be rightly and adequately perceived by the patient, this can be a subject of individuals’ variations. For example, rubbing the hairs and cheering up of a child in a medical session may not look well reasoned by the child’s parent(s). Accordingly, the physician may show sympathy and encouragements just as little and sufficient as possible to balance between his/her emotional generosity from one side and the patient’s understanding and conception from the other.

The 4 ains (عين)

عيادة -eyada- (a clinic), عربية -arabiya- (a car), عروسة -arousa- (a bride), and عزبة -ezba- (a farm) are the 4 عين (ains) that a future physician would be promised – in the Arabic folklore – along his struggle to become a notable physician. In the past, the medical doctors; Arabic: (singular) Tabib or Hakim, were commonly clustered in certain families with special note of nobility and luxury. At those times, medical knowledge and interest were almost inherited like other heritages and the intentions behind medical practice were largely moral. This view has changed dramatically in our present time as the majority of physicians come out of families that might not have a single physician along a whole previous century. As time passed on, and due to other social and economic changes, the physician’s work has become, like other professions, a living-earning work.

In the enchantment of becoming a medical doctor with rising dreams of respect and fame the physician has to accomplish a balance between academic and personal satisfaction and an agreeable financial condition. In this regard, the physician has to afford the main bulk of social burden, compared to other professionals, because a considerable number of people would be unfair in exploiting the beneficent nature or aspect of the medical services especially when dealing with a highly spirited and shy ‘doctor’. Very shamefully is that a kind of ‘tug-of-war’ between the doctor and the patient is not infrequently seen instead of a clear and transparent handling. The drop in the moral attitude of some doctors (service providers) and/ or some patients (service receivers) could be fueled by extremely shallow perception of the medical service and life as a whole from either side or both sides.

My present idea about this ‘financial’ and ‘administrative’ problem of the physician’s work is to declare and ask for the ‘medical service fee’ as long as the context of the medical service permits. In general, the physician should tell the patient and/ or his relatives whether he would need to get the medical fee or he would be able to dispense with it before starting seeing the patient and providing the medical service. One could note every case with date, medical problem and provided service together with the estimated  fee regardless whether it could be paid or not. This archive would help both professional and socioeconomic performances of the physician being a form of medical case and turnover registry.

A new Hippocratic oath ~2010AD

* I promise that my medical knowledge will be used to benefit people’s health. Patients are my first concern. I will listen to them, and provide the best care I can. I will be honest, respectful, and compassionate towards all.
* I will do my best to help anyone in medical need, in emergencies. I will make every effort to ensure the rights of all patients are respected, including vulnerable groups who lack means of making their needs known.
* I will exercise my professional judgment, uninfluenced by political or religious pressure, or the age, race, sexual orientation, social class, wealth, or celebrity of my patient. I will not put profit or my own career above my duty to patient.
* I recognize the special value of human life, but I also know that prolonging life is not the only aim of health care. If I agree to perform abortion, I agree it should take place only within an ethical and legal context.
* I will not provide treatments that are pointless or harmful, or which an informed and competent patient refuses. I will help patients find the information and support they want to make decisions on their care.
* I will be as truthful as I can, and respect patients’ decisions, unless that puts others at risk of substantial harm. If I cannot agree with their requests I will explain why.
* If my patient has limited mental awareness, I will still encourage him or her to participate in decisions as much as they feel able. I will do my best to maintain confidentiality about all patients.
* If there are overriding reasons preventing my keeping a patient’s confidentiality I will explain them. I will recognize the limits of my knowledge and seek advice from colleagues as needed.
* I will do my best to keep myself and my colleagues informed of new developments, and ensure that poor standards or bad practices are exposed to those who can improve them.
* I will show respect for all those with whom I work and be ready to share my knowledge by teaching others what I know. I will use my training and professional standing to improve the community in which I work.
* I will respect each of my roles, as expert, communicator, scholar, partner, manager, teacher, professional, and health advocate. I will promote fair use of health resources and try to influence positively those whose policies harm public health.
* I recognize that I have responsibilities to humankind that transcend diktats and orders of States, and which no Legislature can countermand. I will oppose health policies that breach internationally accepted standards of human rights.
* I will learn from my mistakes and seek help from colleagues to promote patient safety. While keeping within this framework, I will not be discouraged by failure, and will try to continue in a spirit of practical and rational optimism.
* While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art, respected by all, in all times.

We take this oath not because we are doctors but because sooner or later we are all patients. Clause 1 is the central clause. It has a terrible beauty. For many, it is our family that is our main priority. Often we can strike an uneasy compromise with family life.
This page is dedicated to doctors for whom circumstances allow no such compromise: those who have not fled wars, or who have stayed at their posts during epidemics… The above is based on the BMA’s Revised Hippocratic Oath.

Reference: Longmore M, Wilkinson IB, Davidson EH, Foulkes A, Mafi AR: Oxford Handbook Of Clinical Medicine, 8. Edition; A new Hippocratic oath ~2010AD.

Twelve common pits for doctors

common pits for doctors
The relation between the treating doctor and the patient relies basically on mutual trust, respect and dignity. Some psychological element in the response of patient to treatment may be agreed on in this context. However, despite this fundamental requirement for such saintly doctor/patient relation some pits or traps may happen from either side.

Pits from doctor’s side:
1- Patient extortion is a striking sign of corruption when a doctor extorts money or other things from a patient so that the medical service would be provided.
2- Doctor’s egoism may manifest as a doctor cannot tell a patient that he/she does not know how to manage the case or when another more conservative decision has to be made as the case progresses favorably.
3- Defaming other doctors may be immorally made as a habit by some doctors in order to persuade patients to comply with their prescriptions or decisions.
4- Effecting vague symptoms is quite dangerous because many complaints, especially those made by parents in respect to their young sick kids, are exaggerated and need to be tested very carefully.
5- Effecting unclear medical directions given by some senior staff members can expose both patient and young doctor to undesirable and even fatal consequences.
6- Trying insufficiently tested approaches that may be potentially harmful.
7- Reluctance or dispensing with asking for help of other persons, colleagues or more experienced staff members.
8- So-called recommendoma circulates sometimes among doctors, usually as a bad omen, that patients recommended from some medical staff members or personnel would progress unfavorably.
9- Patient’s psychological insult by exaggerating the severity of the case, giving unduly too much medicines or resorting unduly to invasive approaches, e.g. injections.

Pits from patient’s side:
1- Chattering patient is usually a person who is more roaming around his/her luxurious and fulfilled life more than looking for some medical advice.
2- Abusing patient is a person who is trying to trick the doctor for some physical, materialistic or psychological gains.

Pits from both doctor and patient:
1- Driven treatment fault is almost likely to happen when a patient or relative of a patient persuades a doctor to provide some medical service which the doctor accepts on grounds of curiosity and professional itch rather than on scientific and ethical grounds. This problem aggravates in absence of appropriate assistance by other medical staff members.

Suggestion:
The physician has to be keen on having the morals and attitude complying with the highly beneficent message of the medical profession through careful self-judgment and self-criticism and being well acquainted with the relevant ethical and social issues beside the up-to-date available medical knowledge.

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