| Column |
august-september, 2020 | The Health
31
Part of the reason is
that if a pilot does
not maintain the level
of professionalism
in an aviation crisis,
both the pilot and
passengers will
perish. A doctor’s lack
of professionalism
will only adversely
affect the patient
and not the doctor.
Hence, there is a
reluctance to spend
the money to assess
trainee doctors.”
Why doctors
should be impartial
A doctor’s lack of professionalism and integrity
can adversely affect the patient
The doctor-patient relationship
is essentially an asymmetrical
one. For all practical purposes, the
patient has to trust his doctor/s.
And in emergencies, the
patient has pretty much little say
on who the doctor treating him is going
to be. Hence, doctors must maintain the
highest standard of professionalism.
However, it seems there is a steady loss
of respect and regard for doctors among
patients. In the social media era, videos of
altercations between doctors and patients
are not uncommon.
Various “conspiracy theory” videos by
irresponsible parties don’t help matters
much either.
However, as there is an “asymmetry of
knowledge and power”, the issue has to be
addressed.
What are the factors that may
compromise the professionalism and
integrity of doctors?
First, it is aptitude. Doctors are mostly
technocrats with a pleasant and helpful
manner. For example, doctors must
remain calm in stressful situations
while maintaining a laser-sharp focus
on the medical issues at hand. The most
important outcome for a doctor is to have
a successful treatment outcome.
Unfortunately, it is difficult and
expensive to pre-assess a “personality
and aptitude” fit before intake into
medical school. Some professions, such
as the aviation industry, conduct these
assessments for their trainee pilot
candidates.
Part of the reason is that if a pilot does
BY DR MANIMALAR
SELVI NAICKER
not maintain the level of professionalism
in an aviation crisis, both the pilot and
passengers will perish. A doctor’s lack of
professionalism will only adversely affect
the patient and not the doctor. Hence, there
is a reluctance to spend the money to assess
trainee doctors.
Some doctors
should clean up their act
The result of this is that we see doctors who
get into shouting matches with patients,
commit sexual misconduct, are careless and
not detail-orientated or undertake tasks
for which they are not trained. These are
simply people who should never have been
allowed into medical schools in the first
place.
Secondly, is attitude. Medicine, on
average, is a five-year course. Specialist
training takes another 4-6 years. So, doctors
have “invested” more time into their
careers than most other professionals.
For those who had to self-fund their
costly undergraduate medical degree, there
is the added financial “investment” as
well. Hence, some doctors feel they have to
“recoup” their investments quickly and end
up behaving unethically and over-treating
and over-charging patients.
The third issue is the conflict of interest.
It is a doctor’s job to evaluate a patient and
prescribe the most appropriate treatment.
However, this is made difficult by constant
inducements from vendors such as
pharmaceutical companies.
Pharma tends to “reward” easy-to-workwith
doctors with perks such as authorships
in scientific papers, invitations and
honorariums to give “expert” presentations
at international meetings, free food, and
sponsored travel, among others.
It is also much more challenging to
climb the academic ladder without the
support of the pharma industry. Published
research shows that even small “rewards”
from pharma can make doctors biased.
It may have adverse consequences for
patients.
It prompted the US government in 2010
to pass the Physicians Payment Sunshine
Act (PPSA) to shed light on the amount
doctors, and medical institutions received
from pharmaceutical companies. US
patients now can do a background check on
their doctors to make sure that the doctor is
not on pharma “payroll”.
Self-regulation may not be the way
The fourth issue is Continuing Medical
Education (CME). Doctors need to keep up
with the latest in Evidence-Based Medicine.
It requires time, money and skill.
It is quite natural for senior doctors to
become outdated even if they have a busy
clinical practice. Before the 1970s CME was
natural as doctors relied on qualitative
research such as case reports and case
series to update themselves. It required no
particular skillsets to do or read.
But since the 1980s, CME has
increasingly become quantitative. A degree
in data science is required to do or read the
research. Most doctors (including research
physicians) have no such training.
Hence, they are dependent on pharma
(either directly or indirectly) to “educate”
them. It is not going to make patients happy
as a doctor’s informed opinion is supposed
to be independent and impartial.
There should have been an overhaul
of the medical education and regulatory
system years ago. But, since medicine
is so highly technically specialised,
governments, somewhat reluctantly, are
forced to allow doctors to self-regulate.
The consequence of this is maintaining
the status quo as doctors find it too painful
to change.
Some countries, such as the United
Kingdom (UK), have removed the ability
to self-regulate from doctors. The General
Medical Council, UK now has members of
the public on its council. It is high time
Malaysia followed suit. — The Health
Dr Manimalar is Medical Lecturer and
Consultant Histopathologist & Statistician,
Department of Pathology, Faculty of Medicine,
University of Malaya