The fine line

2017-11-06T23:07:15+05:00 Raja Khalid Shabbir

Paracelsus, a Swiss physician credited as the father of toxicology says, “Medicine rests upon four pillars – philosophy, astronomy, alchemy and ethics.” Regrettably, we have failed to incorporate medical ethics in its true sense in our healthcare system.

The recent turbulent winds have signaled the start of a new debate, this time involving a social media activity. This tale, involving a doctor of Agha Khan University Hospital (AKUH) sending a friend request to the sister of two-time Oscar winner, who came to the emergency room as a patient, reeks of unprofessionalism, over-reaction and abuse of power. After this incident, a series of tweets by the Oscar laureate claimed this act as harassment and even went on to say that “Pakistan has no boundaries.” What needs to be known is that we have fallen short of identifying the very fine line between unprofessionalism and harassment.

Jemima Goldsmith, a British-Pakistani journalist and socialite, was flooded with more than one thousand phone calls and hundreds of text messages from a Pakistan-origin cab driver between June 2016 and July this year. The cab driver used 18 different phone numbers for this year-long harassment campaign. This incident, when compared with the needless uproar revolving around a social media request, helps in deciding whether clicking a button on the internet qualifies as harassment or not.

Having spent overly-stretched hours for the past many years within the confines of hospitals, I have come across quite a few cases of misconduct emanating from both the patient’s as well as the doctor’s side. At the start of this year, a shocking revelation was made about the illegal business of fake cardiac stents but no one was held accountable for playing with precious lives and the whole incident was swept under the carpet- out of sight and out of mind. Similarly, many incidents involving physical and verbal abuse on doctors at the hands of patients and their attendants have gone by uninvestigated.

The relationship shared between physicians and their patients is in fact a salubrious alliance directed towards improving the patient’s health status and quality of life and needs to be dealt with extreme caution and care. Stemming from sensitivity, this relationship is comparable to a scenario in which a crotchety one year old holds a precious piece of ornament in his unstable grip. Any wrong or sudden move by the caretaker may lead to losing the delicate item.

The foundation of a doctor-patient relationship rests on trust, respect and confidentiality. These when practiced in their true nature increases the comfort level of a patient, allowing him/her to entrust the doctor with every minor detail, how personal it maybe, about the disease or injury. This ultimately helps the doctor in achieving optimal diagnostic and therapeutic goals.

In the past, the model for doctor-patient relationship comprised of absolute patient dependence on the physician’s professional authority. If the patients concerns and preferences conflicted with the physician’s views then these were ignored and the physician’s decision was taken as the final verdict. With time, this relationship evolved to become a mutually shared one, with powers vested in both the parties. The model now followed incorporates the concept of patient consent. Complete information about the disease, its different treatment options, complications and prognosis (outcome) is given to the patient who then makes an informed decision in view of his/her personal opinions and values.

The earliest form of medical ethics in the Western world is the Hippocratic Oath, which was written between the third and fifth centuries BC and incorporates principles which as such are still of utmost importance today. Approximately 9000 articles, books, chapters and numerous ethical guidelines by different organizations like American Medical Association, Centre for Human Bioethics, Ethics committee etc. have been put forth. But still unethical practices in hospital settings are not a rare occurring.

In what is referred to as an over-reacted decision under the pressure of influential names, this whole social media fiasco has left the AKUH doctor unemployed with four kids to take care of. Perhaps the only silver lining in the backdrop of this grim episode is that specialties like radiology, pathology and anesthesiology (to some extent) which involves minimal or almost zero doctor-patient interaction would flourish and shortages in these fields would be filled up.

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