Dr. Arun Mitra
Weakening of sacred patient and doctor relationship based on mutual trust is a cause of serious concern. This is understandable to an extent because medical practice has undergone a transformation in the last few decades. Increasing corporatization and extraneous considerations have made it too much techno centric. Healthcare, which at one time was considered as a social responsibility, has seen a shift. Even the WHO has started putting more focus on individual responsibility. Agreements like Alma Ata declaration seem to have taken a back seat. For the vast majority, healthcare remains a serious issue around the globe, more so in the developing countries where public health spending is far from the desirable level. Primary healthcare is the biggest victim. Advanced tertiary healthcare has largely been left to the corporate sector making it inaccessible to vast majority of our population. In the pursuit of defensive medicine or under the pressure of other considerations, patients in many cases are being subjected to either under care or over care.
A large number of the medical professionals around the world have got swayed away with this new wind. There are others who feel upset but do not care to speak. But many a professional in different countries have taken up the issue of ethics in medical practice vis a vis responsibilities and rights of doctors and patients with the ultimate aim of how best to impart health care to the society. Going by the definition of Right Care from the Right Care Alliance, which is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and put patients, not profits, at the heart of health care. (https://right carealliance.org /about), “Right Care is a human right. It places the health and well-being of patients first. Right Care is affordable and effective. It is compassionate, honest, and safe. Right Care brings healing and comfort to patients, and satisfaction to clinicians. Achieving Right Care will require radically transforming how care is delivered and financed”.
In 2002, the reputed Italian cardiologist Alberto Dolara published an article in the Italian Heart Journal, a scientific publication, where the term Slow Medicine was introduced. Dolara stated “In clinical practice, hyperactivity is often unnecessary. Adopting a strategy of ‘slow medicine’ may be more rewarding in many situations. Such an approach would allow health professionals and in particular doctors and nurses, to have sufficient time to evaluate the personal, familial and social problems of the patient extensively, to reduce anxiety whilst waiting for non-urgent diagnostic and therapeutic procedures, to evaluate new methods and technologies carefully, to prevent premature dismissals from hospital and finally to offer an adequate emotional support to the terminal patient and their families.”
The crux of health care thus is to ensure that it is affordable, universal, without financial considerations as priority, utilizing technology but not techno centric. It should be based on sufficient dialogue between patient and medical practitioner to develop confidence. It is based on social concerns and linked to the issues of food security, housing, water supply, sanitation and job security etc.
According to the Indian Medical Council (professional conduct, etiquette & ethics) Regulations, 2002, “A physician shall uphold the dignity and honour of his profession. The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration”.
The ethical approach of a doctor is built over a period of time right from admission to medical colleges, finances involved in it and type of training in these institutions. Further it also depends on the type of health care services prevalent in the country, relationship with drug companies, code of ethics for medical professionals and pharmaceutical companies and socio-economic conditions around.
It would be naive to expect doctors to work like saints. In the type of set-up that we have in our country at present, doctors have to work under much pressure and are under allurements from drug companies. There is also pressure from other professional colleagues for cuts and commissions for referrals for clinical care and diagnostics. Doctors are also under constant fear of violence, most of the times for what is not medically wrong. The task for right and ethical care thus has to be integrated into all these issues.
This is, however, not easy. Medical professionals in different parts of the country have been continuing their effort in that direction in different ways. Doctors in Maharashtra researched and interviewed doctors leading to the publication of the book “Dissenting Diagnosis”. This contained confessions by many doctors as to how they had to face problems in carrying out practice ethically. Difficulties of implementing ethics even in the position of power are not less. The experience of Punjab Medical Council must be quoted where the Minister for Medical Education intervened at every step to sabotage steps to streamline medical practice on ethical lines.
It is to the courage of physicians of similar ideas from different countries that they have decided to hold a conference on ethical healthcare on 21st and 22nd April 2018 in New Delhi. We should hope for a positive outcome and strategy planning on larger scale in the time to come so that we can achieve universal healthcare for all our citizens. (IPA)
Ethics in Medical practice
Dr. Arun Mitra