Judging doctors

Thursday, July 23, 2009 Posted by admin at 8:12 PM | Labels: ,

"S'pore-trained docs more lenient on peers' ethics," says the title.

A rather bold statement to make, especially in light of the current limelight on self-regulation of the medical profession, but surely a factual one, given the fact that it is based on a study by doctors?

Well, not quite.

While one may conclude that there is a difference between repsonses from local grads and overseas grads (IMG is such an awkward term, isn't it?), the title could easily have been "Foreign-trained docs more willing to condemn colleagues", couldn't it?

I read through the vignettes given in the paper, and frankly I would only have recommended one of the three HOs to be struck off - guess which one.

I'll give you a clue: in only one of the three scenarios given was it implied that patient-care was compromised; the other two were not about clinical care, or medical ethics, but *work* ethics.

The survey was not really about "ethics", but about "professionalism". In fact, these scenarios are not the typical types brought to the attention of the SMC Disciplinary Committee - those are predominantly about inappropriate prescriptions.

The authors of the paper probably chose the scenarios they did based on the subjects of their survey, which of course limited their choices.

Nevertheless, I am rather disturbed by the fact that the HOs involved in the survey are so quick to strike off one of their own based on a brief vignette, but perhaps it is easy when you reduce the questions down to their bare minimum, and ask yourself:

1. Should a doctor be struck off for being a jerk?

2. Should a doctor be struck off for being irresponsible and dishonest?

3. Should a doctor be struck off for being a sex offender?

But surely when the DC is considering a case, the question they ask is:

Should *this doctor* be struck off?

Perhaps that's why HOs are not put on the SMC DC...

4 comments:

spacefan said...

I'm always wary of such studies. First, the results can be manipulated to suit the authors' or the media's own motives.

The ST headline screamed "S'pore-trained doctors more lenient on peers' ethics", but the original article's title is a more neutral-sounding "New house-officers' views on unprofessional behaviour".

Second, as rightly pointed out, the issue being discussed is "professionalism" rather than "ethics".

Third, is professionalism considered something that needs to be taught?

I graduated from NUS 10 years ago, and learned most of my everyday skills on the job. Treating colleagues with civility and respect should be intrinsic. After all, only the cream of the crop is selected for Medicine. Surely these smart young adults know the difference between right and wrong?

Sadly, whatever educational module / tests / exams you incorporate won't matter if the student chooses not to practise what s/he has learnt.

My personal experiences with the younger generation of MOs are often unpleasant. Not too long ago, a junior MO had the nerve to yell at me over the phone when she refused to see a patient and I called her registrar.

Forget about tweaking the curriculum. Try tweaking your med school admission process.

24 July, 2009 13:58
angry doc said...

Heh. Why don't you just say it: you expected something better from the authour. :)

While the specifics of what constitutes a profession's professionalism must be learnt by immersion, I suspect a person's willingness to comform is determined by indoctrination from earlier on (see Gigamole's post on the same subject), which is harder to snap out of - it took me years to realise that 'work ethics' was just a way to make people work harder without rewarding them in return.

24 July, 2009 21:40
Anonymous said...

Yet another article seemingly tailored to the current debate regarding our DCs...


http://www.straitstimes.com/ST+Forum/Story/STIStory_408859.html

28 July, 2009 11:34
Robin said...

hmmm..

So what went wrong? The doctors interviewed are HO, who are fresh graduates from the University. Some said that Medical and Professional Ethics were not taught well (as a subject) in school. Some complained that students nowadays have more IQ but no EQ. Some thought that HOs are suffering from compassion fatigue after seeing too much angry and demanding patients and their workload are too much to handle.

To be a doctor, their karma must be either the best or the worst. The Best... because they can help everyone in their life time, hopefully to reduce their suffering and pain. The Worst.. it can be emotional and physically straining if you are not up for it.

I remember my old professor, who was extremely strict to his students, always failed half of his students during exam. He always reminded us that if we are 99% accurate, we are killing 1 patient out of 100. And it is his duty to make sure only the best students will graduate from his class, or else his students will be a weapon to kill the patients.

If teachers are not teaching their students good ethics and not showing good ethics themselves, this is the cause of more suffering (especially now, it is a wake up call for the medical profession).

So when do you learn about ethics.. is it in school? or during one's medical practice ?

30 July, 2009 10:10

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