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Doctors are not messiahs

What is the basis of professional medical ethics?

Doctors are not messiahs

Every so often I have to point out a few things about doctors. The first of course is that most of us are not messiahs and definitely have no desire to be referred to as messiahs. There are many reasons for this but the most important one being that most avowed messiahs do rather poorly in this world.

My favourite messiah from a few hundred years ago is Shabbetai Zevi, a Sephardic Jew who declared that he was a messiah. Zevi was quite successful and accumulated a relatively large number of followers. However, the Jewish establishment of that time disputed his claim.

The matter eventually reached the court of the Ottoman Sultan where Zevi was told that under Jewish law he would be executed for ‘blasphemy’. But if he converted to Islam he would avoid execution. Zevi converted and his followers have lived in Turkey since then.

Another reason why the possibility of physicians becoming messiahs is becoming statistically less likely is that messiahs have to be of the male persuasion. And at present a significant majority of medical graduates is of the female persuasion and as such are entirely unsuitable for becoming messiahs.

So my advice to all doctors is that they should avoid even thinking privately of being messiahs. And they should threaten to accuse all journalists, politicians and other such with blasphemy if they call any living person a messiah.

Another one of my pet peeves is doctors being asked to serve ‘ailing humanity’. Service to humanity at large is the job of public health officials and of medical researchers that invent or discover methods to help a lot of people. Such people are worthy of fame and fortune.

However not all such servants of humanity get the recognition they deserve. A little less than two hundred years ago Ignaz Semmelweis, a Hungarian surgeon, found out that the large number of women dying from infection during childbirth could be markedly decreased if doctors just washed their hands before attending the delivery of a child.

Sadly this ‘benefactor of ailing humanity’ was ridiculed by the existing medical establishment for making such a stupid claim. He ended up in an ‘insane asylum’ where he died after being beaten up by an attendant. His British contemporary, Joseph Lister who advocated similar techniques to decrease ‘surgical’ infections went on to become a Lord. Many of us even use mouthwash today named after him.

So in my opinion an attempt to benefit ailing humanity can be a fraught activity. As such doctors should preferably concentrate on helping one human being at a time and leave the rest of humanity alone. Of course there are people, and not just among doctors that do indeed want to help all of humanity, ailing or not. Good luck to them I say.

If we look at all those that did actually take oaths before assuming important public positions in Pakistan, it would seem these oath takers pushed more Pakistanis into the ranks of ailing humanity than they probably would have done if they had remained ‘oath less’.

Another slightly lesser pet peeve of mine is about some oath that doctors take that obliges them to behave in a certain way. That mostly means that doctors should take care of the above-mentioned ailing humanity even if they themselves are paid little and work in poorly-equipped and staffed medical facilities.

Here I wish to point out that the only ‘oath’ I ever took was when I joined the Boy Scouts of Pakistan some sixty plus years ago. Fortunately for me I left the Boy Scouts even before I earned a single merit badge. But I took no oath when I graduated from King Edward Medical College (KEMC/U) in 1970, nor did any of the fresh graduates during my time on the aforementioned faculty more recently.

However if we look at all those that did actually take oaths before assuming important public positions in Pakistan, it would seem these oath takers pushed more Pakistanis into the ranks of ailing humanity than they probably would have done if they had remained ‘oath less’.

In short, as a physician, I accept many medical responsibilities because they are my professional obligations and not because I am a messiah or have a burning desire to serve ailing humanity or because I took an oath to do so. I practice medicine because that is what I do to make a living. And that is true of most doctors as it is of members of every other profession.

Here it is important to separate personal ethics from professional medical ethics. We have already imbibed the ethical basis on which this society functions. Honesty, truthfulness, empathy, sympathy, religious values or their lack are already a part of us before we even decide on a career.

The first image that we need to get rid of when we think of a doctor is of the kindly white haired TV doctor who was more a ‘father confessor’ than an actual medical healer. A doctor today can be kindly and white haired but he has to know so much more to practice modern medicine.

What then is the basis of medical ethics? Simply put, a practicing physician must be able if needed to use the newest technology to diagnose disease and then must be able to offer the latest and the best available treatment alternatives to the patients. In other words even if a physician graduated and completed post graduate training many decades ago, he or she must keep with the latest developments.

Continuing medical self-education in my opinion is the basic ethical requirement for a modern physician. Most state licensing systems in the United States, for instance, require many hundred hours of continuing medical education (CME) credits approved by the American Medical Association (AMA) before a medical license can be renewed. Specialty boards like the American Board of Internal Medicines (ABIM) expect their diploma holders to retake the board examination every ten years if they wish to maintain board certification.

Also hospitals only allow appropriately licensed and board certified physicians to practice their specific medical specialty. And the ultimate weapon that forces medical proficiency is the requirements for physicians to obtain malpractice insurance. The insuring company then assures that the physician is indeed qualified to practice medicine before providing them with insurance.

At the same time legal actions against physicians that have ‘bad’ results also enforces what is referred to as the standard of medical practice. The best defense against malpractice judgments is adherence to established standards of medical practice not only by physicians and ancillary medical staff but also by the hospital administration.

And yes, I believe it is entirely ethical for a physician to make the best living possible by practicing ‘good’ medicine. But there are a couple of ethical constraints here. First is that the fee charged shall be such that the patient can pay it without selling his or her first born child. And second is that patients will not be denied treatment if they are unable to pay for it.

Even though it is not an ethical requirement but all physicians in a position where they can teach younger physicians should the best they can.

And, ask for help if you need it. As Dirty Harry, that great American folk philosopher said so famously: “A man must know his limitations”. That applies to doctors as well.

The author served as professor and chairman, department of cardiac surgery, King Edward Medical University.

Dr. Syed Mansoor Hussain

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