Dr. Death-Time to Learn
The medical field faced some hard realities when Harold Shipman, also known as Dr. Death, was convicted of killing 15 people. As a matter of fact, he is believed to have killed 200 of his patients. This was a rare incident but raised major concerns about the reputation of the profession and the significant risks attached relating to the observance of ethics in the practice.
The question, that I would put crudely is that, whether the technological advancement in the medical field is of any benefit to the humanity or is it only to benefit those who can afford expensive hospitals observing strict quality control standards and conforming to international benchmarks. If careless doctor misdiagnoses a disease because of being unaware of his/her legal responsibility in this regard, are the better researched drugs of any use to that individual patient? Any advancement in research and development in the field of medicine we have achieved in the twenty first century would be undermined if the regulatory and ethical requirements are not simultaneously promoted, educated and implemented throughout the globe.
This article would refer to the instances of various levels of violation of professionalism and how education, media/social awareness and use of global benchmarks are relevant to addressing the related risks.
In Pakistan, unfortunately the height of irony is that, doctors are themselves not educated about their legal and ethical duties relevant to their practice and how exactly PMDC is supposed to regulate them. As very rightly highlighted in an article by Muhammad Shahid Shamim ( Medical Education Cell, Dow University of Health Sciences, Karachi. ) that PMDC curriculum clearly advices teaching of medical ethics to undergraduate medical students, but this topic is not formally taught or examined in many universities. How on earth can we expect a doctor to fulfill his duties who is simply not aware of them.
An incident which resulted from this very culture of negligence appeared when GMC united Kingdom awarded major punishments including ban to 79 Pakistani doctors. Most of these doctors were charged for professional misconduct, keeping incomplete record of the patients while practicing in the UK, misdiagnosing, poor clinical findings and communication with patients-It would not be a misstatement to say that the practices which led to punishments in UK are actually a norm in Pakistan.
It is not idealistic to compare our condition with GMC to suggest better education and enforcement of professional standards. Even in Pakistan, certain fields have proper education of ethical requirements and a vigilant process to ensure the enforcement of these. For example, in the field of chartered accountancy it is recognized that every practicing individual has relevance to the pubic interests, hence the duties and the consequences of not fulfilling those duties are not only taught but also examined(regulated by ICAP).
The implications of not educating our doctors properly and not making them psychologically responsible for certain unprofessional behaviours are wide spread and is facilitated by the weakness of regulatory framework. But this negligence turns into fraud and violation of fiduciary relationship with the patient when the doctor has no social accountability.
Pakistani media needs a paradigm shift in addressing the matters relating to medical profession. Issues such as this must be treated as the highest form of corruption and must be clearly perceived to be of significant threat to the general public interest by the senior analysts.
It is frequent for doctors to issue fake medical certificates and it gets contentious when the certificate has legal implications. a story published in dawn highlighted a report by the district police officer Khanewal, which pointed out 66 fake medico-legal certificates which facilitated people to register cases against the rivals. More frequent are the instances when doctors are approached by pharmaceutical companies and laboratories for recommendation of their brand against commission-hence hampering the objectivity.
But in Pakistan matters get much worse when lack of awareness and the resulting lack of professionalism, gets the opportunity to ripe into hardcore corruption. One such case appeared when the FIA identified 14 such cases of doctors who were issued eligibility certificates on bogus degrees. The inquiry report recommended referring the cases to NAB, if unacceptable, then criminal cases could be registered U/Ss 420, 467, 468, 471, 109, 409 PPC R/W 5(2)47 PCA.
In holding people accountable, the foremost responsibility should be attached to the relevant regulatory authority and the flaws in the framework should be given major consideration. It is no less than a national calamity when there are indications of corruption on part of PMDC and must be treated by the media as such.
It is significant to point out that due to lack of awareness of “patients rights” on the national level media could not deal with the doctors strike in Punjab with due skepticism. PMDC was hindered to take action by the parliamentary standing committee. There was no follow up by the media as to what measures have been taken to prevent the repetition of such events, how to ensure the enforcement of PMDCs ethical requirements on the doctors going on strike and whether a national consensus or legislation is required to save humanity when it is confronted with materialistic wants. A report in dawn claimed that there are more than 70000 bogus degrees in Pakistan. More is the number of paramedics practicing as doctors. Media and social media can help by spotting them and warning against the consequences of consulting them.
For a uniform effect of better health facilities throughout the world, formation of global standards can be considered as an ideal. A few Individual hospitals with high quality controls are not of much relevance to the individuals who are being exploited at another corner of the city.
Introducing international benchmarks would not only improve the reputation of the profession in the country but would also help media and civil society to compare the culture of ethics with other countries and hold the relevant professionals accountable.
It might be shocking for many in Pakistan that wiki rational has categorized homeopathy as pseudo science. We need to introduce global perspective on alternative medicine and therapies in our society and determine the nature of diseases where it is considered too dangerous to rely on alternatives and limit the scope and extent of the procedures used by such practitioners.
Unless proper attention is given to the need of better professionalism and ethics in practice and vigilant monitoring and regulation, despite advancements in technology and medicine, doctors will keep turning into agents of death .
About the author: Ammarah Shailkh is a second year medical student at Sindh Medical College and is an aspiring young writer. She can be reached at: Email: [email protected]
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