An Issue Of Trust

Prof. Lee Wei Ling's recent commentary in The Straits Times struck a deep chord with me.

She related her experiences with medical colleagues and, in particular, touched on the topic of character.

There haven't been any follow-up Forum page discussions - yet. I wonder if readers agree with her wholeheartedly?

Integrity - or the lack thereof - is always something one should be concerned about in any profession, but perhaps more so in medicine. Whether we want to admit it or not, doctors wield tremendous power in many ways, whether it's sticking instruments into body cavities or getting a patient to divulge his / her deepest, darkest secrets.

However, honesty deserves to sit at the top of the list because doctors are human, i.e. we make mistakes, and yes, some patients will die as a direct result of our errors.

Such lapses are likely to be more pervasive among junior doctors, but even the most senior consultant is vulnerable, given the right conditions - sleep deprivation, a slip of the hand, an accidental miscalculation of a drug dose.

What comes next is the real test of one's character: will the doctor admit his/her misstep, or will s/he try to ( a) cover it up and hope no-one finds out, or ( b) blame someone else?

Medicine differs from most professions because it relies significantly on the honour system, encompassing everything from history-taking to physical examination to drug administration. Whatever we do is reflected in "medical records", which are predominantly documented by the physician/s attending the patient. Naturally, the accuracy of this documentation is dependent on the doctor, who may opt to omit certain information if s/he chooses to.

While there're many mechanisms / protocols in place to ensure that the patient is protected, no system is foolproof, which is why integrity is key.

One quote rightly states that "Integrity is doing the right thing, even if nobody is watching." Do doctors fulfill the criteria?

Based on my personal experiences in the local context, I would say that most do, but a few black sheep exist.

Here's a gist of 2 of the worst incidents I've ever had the misfortune to be involved with ( obviously, specific details can't be published ).

1) The unexpected death of a young man which resulted in a hospital inquiry.

A medical colleague - A - who took over management after I had started initial treatment, accused me of not following his/her supposedly explicit instructions to send the patient to a certain ward for close monitoring.
The truth: I never received such instructions, and was only told by A that s/he would see the patient urgently, and to please run a fast drip in the meantime.
In the end, the patient was not reviewed by A until 8 hours later, when he began to deteriorate.

My mistake was in not documenting the phone call I received from A, choosing instead to take him/her at his/her word. This resulted in an I-said-A-said confrontation before the inquiry panel, during which I witnessed A's Oscar-worthy portrayal of self-righteousness, and couldn't be sure whether s/he believed his/her own lies or not.

Thankfully, the panel saw through A's performance, and delivered a well-deserved censure.

2) B, a high flyer in the medical community, took it upon him/herself to steal a vial of antibiotic from Hospital X, brought it to Hospital Y, and administered it to his/her boy/girlfriend - C, who was warded for a fever of uncertain origin.
C also happens to have a documented allergy to a drug which is known to have cross-reactivity with the antibiotic that B administered.

When the ward nurse found out about it and filed an incident report ( complicated story ), B consulted a lawyer relative, then told C to "take the fall" - i.e. say that s/he was the one who asked B to bring the antibiotic over to inject it.

In a desperate bid to save B's skin - and the relationship - C agreed to the plan, and B was never disciplined.


I have always felt that doctors are held to a higher standard than other humans, and for good reason. Medical students are gleaned from the cream of the crop, possessing the requisite high IQs and ( hopefully ) equally high moral standards. But with this intelligence comes the ability to manipulate and deceive. And I have noticed firsthand the inverse relationship between academic excellence and guilelessness in many of my fellow doctors.

A simple med school entrance essay and interview can't differentiate the good from the bad, and even the best person can degenerate over time.

All I can tell you is, the medical profession is far from perfect.