I wonder to what extent doctors nowadays see themselves as having a principal role in being advocates and activists on behalf of patient welfare and well being. Or are they primarily concerned with their own material and professional well being, and see patients as being obstacles in their achieving their ends?
Your thoughts?
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I still see myself as an advocate for my patients in terms of demanding quality clinical care standards not just from myself but also from my colleagues.
I find this blog fascinating and do like to hear the views of doctors regarding matters of public interest. I’m not a medical doctor, but thought the doctors here might be interested in a layperson’s views. I am interested in not just the role of individual doctors in patient care, but the medical profession as a whole. I do wish that the medical profession here can take a more active role in important medical and public health issues of the nation, not just in patient care and clinical standards, but in advocacy and policy.
I personally see some of the population policies of the PAP government especially those that border on eugenics to be a dark aspect of our society, but in books and academic papers I have read, the medical profession particularly the Singapore Medical Association, to be almost a non-entity in the analyses of what happened despite the role medical doctors play in issues of reproduction and population. Maybe, it is just too much to ask for activist group of doctors given how the Law Society ended up when they tried that.
There are more current issues now such as the disparity in antenatal and infant outcomes of the different ethnic groups, affordable health care among the poor and old, etc. There’s scope for advocacy at that level, I feel.
Nicely said FA. I certainly welcome non-medical voices here.
I also agree with you re the passivity of the medical profession. The SMA has lost much of her voice, and has become somewhat inward looking and self serving, and exists now more as a club than being a professional gathering. This is partly the reason for my post here. Few doctors would now stand up and champion the rights of patients, and/or even campaign to improve patient's welfare/well being. But they only become pretty outspoken if anything cramps their style.
I know I am making quite a lot of unsubstantiated generalizations here,....but perhaps that's my prerogative to vent as a member of the profession.
When I posted this, I wasn't aware that the ST would carry a report on www.CancerStory.com, under the heading Patient Advocacy. Pure coincidence.
I don't necessarily agree with Ms Lee's approach, but it just struck me as sad for the profession that such advocacy should emerge from the lay public.
There's a malaise in the profession, and as doctors, we should heed the patient's complaints.
I personally think doctors as a profession should not take up any form of advocacy that are not based primarily on science.
Take for example the "affordable health care among the poor and old". Is that really a medical problem, or is that a social problem? The economic condition of the poor and some of the old impacts not only on their medical care but also other aspects of their lives - why should doctors, as a profession, advocate for a social problem just because it overlaps with a medical problem? Anyone can say that the poor should receive more help (with healthcare, food, utilities, transport, etc.) and advocate for them - it doesn't take a doctor or a medical association to call for lower price-tags.
I believe what doctors should take up advocacy for are areas specific to their knowledge, like health promotion and the dangers of certain forms of alternative medicine (yes, that's my personal crusade). Certainly there is nothing wrong with doctors taking care of their own interests.
As for improving "patient's welfare/well being" I think those are just non-specific terms that sound good but say very little. We need to be concrete about what issues we want to take up, and why.
Gigamole – Thanks for the website. I’ve never heard of it, but I find the website story both tragic and illuminating. The title of the book is really striking.
Angry Doc - The medical profession should not be everything to everyone, I agree. But when some of the biggest predictors of health risks and outcomes are social in nature and go beyond the acute medical setting, I feel the medical profession should have a role to play in these areas. I suspect that if you agree to this statement, both of us do not differ actually. The health promotion that you mention then becomes advocacy and outreach to combat social causes/correlates of medical problems. As for the poor and old, yes, it is a more general economic problem, but it does not mean that the medical profession cannot do anything about it to help in its own specific area of health/medical access.
Let’s be more specific as argued. I was shocked when I read in a scientific article some time back that there are still mothers in Singapore mostly those from the lower educated, economically disadvantaged, minority groups who only visit the gynecologist/obstetrician when they want to give birth. By that time, problems like iron-deficiency, etc. would have been too late to prevent and the unborn has to suffer potentially for the rest of his/her life. The origins/causes are complex, social and economic, but surely the medical profession has a role to play in addressing this issue.
In any case, keep up the good blog docs!
Methinks you might be missing the point here, AD.
The patient clearly isn't just a medical 'case', but a patient in the context of his family and community. Can we really separate his clinical problem from the problems affecting his family and community.
"The economic condition of the poor and some of the old impacts not only on their medical care but also other aspects of their lives - why should doctors, as a profession, advocate for a social problem just because it overlaps with a medical problem?"
Do doctors blind themselves to the wider dimensions of the patient's problems? Sounds like a bit of a cop out to me. Wasn't all this part of the social medicine and public health lessons that all doctors were supposedly taught?
"As for improving "patient's welfare/well being" I think those are just non-specific terms that sound good but say very little. We need to be concrete about what issues we want to take up, and why."
Of course these were couched in generalized terminologies. This is just a constraint of the post. The question I had posed was whether doctors were prepared to look beyond the clinical problem (or the science as you out it), the practice problems and to advocate on behalf of patients with respect to broader issues that benefit the patients' welfare. These could be reducing health care costs, improving hospital efficiencies/mistakes, improving doctors' empathy for their patients, or just simply not be so damn rude to patients. Yes, these do matter, and are part of the overall compassion and care we extend to the patients. It doesn't necessarily have to be 'scientific'. Just compassionate.
The patient isn't just a diseased organ.
I got the point, gigamole - I just disagree with it.
We all exist in the context of our work, family, and society - but why should patients and doctors have the expectation that the problems patients encounter in those areas should be handled or fixed by doctors?
A patient isn't just a diseased organ, but a doctor studies, diagnoses and treats diseases.
Compassion doesn't cure cancer, and you don't need to go to medical school to learn compasssion. (I went to medical school and obviously didn't learn it.)
The put my point another way, gigamole:
When does something NOT become a doctor's problem?
In short, nothing. In long, a doctor is more than a treater of a disease.
Here are two quotes from a wise physician. Admittedly they may sound quaintly outmoded by today's value system - but I think we'd be well advised not to forget ...
“By far the most dangerous foe we have to fight is apathy - indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction”
“Care more for the individual patient than for the special features of the disease. . . . Put yourself in his place . . . The kindly word, the cheerful greeting, the sympathetic look -- these the patient understands.”
Sir William Osler
"In short, nothing."
I don't think that is a realistic expectation.
Well, in truth, doctoring is profession that is extensively engaged in the community and in pretty much all aspects of it's functioning. I think unfortunately in recent times, we have passively defaulted too much engineers, lawyers, accountants and 'managers'.
It's a kind of learned helplessness, so that our voices become muted and our ability to engage problems in society become limited to those in our comfort zones.
I personally would like to see doctors get more engaged in championing patients' causes that are less limited by the walls of their clinics or laboratories.
FA,
Your specific example allows me to clarify my point.
Certainly doctors see the end results of poor socio-economic background, and certainly they want things to improve - but are doctors the people with the best knowledge to solve these socio-economic issues? Do they have the necessary background knowledge that allows them to suggest effective solutions? If not, then isn't such advocacy just about cheerleading and making ourselves feel better? I'd rather doctors then just take a pay-cut quietly instead of spending time and resources making like they are trying to solve all the world's problems.
Do what you are trained for.
"It's a kind of learned helplessness, so that our voices become muted and our ability to engage problems in society become limited to those in our comfort zones."
I think so too.
But I don't think it is necessarily a bad thing. I think our "comfort zone" should be our "area of expertise". We should build up the reputation that we provide good-quality, evidence-based care, and that we ensure quality amongst our own. That, I believe, is what we should stand for, and that, to me, is advocating for patients. It's not glamourous, but I think that's something we can have a quiet sense of pride over.
If we wish to engage an issue which is 'social', then we should approach it with a starting point based on science and evidence, and propose a solution based on the same, rather than to take an emotive, in-the-limelight issue and just clamour for change without suggesting why and how.
No, doctors don't have nor should claim to be people who have domain specific knowledge about all their patients' multifaceted problems. But this 'technical ignorance' shouldn't stop a doctor from wanting to find a non-medical solution to the patient's problems.
What distinguishes doctoring from many other professions is the level of empathy and sympathy he has for his patients. This compassion should drive him outside of his comfort zone to try and find solutions on behalf of his patients. Or at the very least, opt to be the person that will help give voice to the patient's helplessness when no good solutions seem to exist. Thus would a doctor become an activist and an advocate for his patient(s).
Because, the alternative is to just throw our hands up in despair and default to the economists to find a bottom line approach, or a lawyer who will tell you the laws do not exist to allow it to happen, or the engineer who will tell you it hasn't yet been invented, or the manager who will tell you you are spending too much time with the patient.
Doctors should not be limited by, and to, the medicine they learn, but by the compassion that moves them.
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