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Rapid Responses: Rapid Responses published:
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We need “ethical” doctors!
- Dr Mohamed Sakel (4 January 2009)
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Ethically defend the bashed doctors
- P Lim (4 January 2009)
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A problem halved....
- David R Warriner (5 January 2009)
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'If the Hat Fits, Wear It'
- Kandappu Mylvaganam, Dr Jo Balderamos Price (9 January 2009)
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The twin towers of medicine and ethics—a problem of our concern.
- Tanu PramanikBSc.MA(Sociology), Prof (Dr) Jogenananda Pramanik.MD Faculty of Medicine,MAHSA College,Kuala Lumpur,Malaysia. (9 January 2009)
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Dr Mohamed Sakel, Director Neurorehabilitation, Director R & D,Consultant Physician East Kent University Hospitals, CT17 0HD
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I’ll ‘politely’ challenge Sokol’s conclusion1. Doctors and ethicists working together are not sufficient. Doctors need to have a firm grasp of ethical principles and an instinctive ethical mindset. A modern doctor has to be good in other non-clinical skills e.g. communication, negotiation, generating and measuring patient satisfaction, to name a few. Medicine is grounded in science. However, exercising medical skill requires value judgements. That value system needs to be informed by ethical considerations. A defining characteristic of doctors is their ability to deal with uncertainty2; ethical training can enhance that ability. Ethical guidance will be a valuable addition in the formal direction that we get from professional codes and law. Lord Darzi is proposing to bring in a new era in NHS where doctors will become the leaders. Vision, strategy and communication skills form only part of leadership. Successful leaders are authentic, ethically sound and trustworthy. Hence, people follow them. Surely, we need research evidence that ethically sound clinical practice provides a better care for the patients. Doctors need to be able to generate philosophic inquiry to add to the body of knowledge that is created by empirical research. The solution is to consciously add a new dimension- “ethical aspect”, in all activities or proposals that we make. Ethicist and doctors can work together to create that culture. References: 1. Sokol D K. “But you are not a doctor”. BMJ 2008;337:a3077 2. Godlee F. Understanding the role of the doctor. BMJ 2008;337:a3035 Competing interests: None declared |
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P Lim, Doctor St George's Hospital
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I am a Medic and I can relate to much of what Mr Sokol wrote. I think Ethicists can potentially be extremely helpful if they facilitate in shaping public opinion against the continuing tide of doctor bashing. The furore with organ retention has now made post mortem examination a dying art, patient confidentiality is making research increasingly difficult, the diminishing NHS funds channeled to pay for heavily lobbied expensive treatment, and the list goes on. Competing interests: None declared |
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David R Warriner, CT1 Diabetes Northern General Hospital, Sheffield, S5 7AU
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I think, uncharacteristically, Daniel Sokol is missing the point. I applaud his attempts to get stuck in at the dirty coal face, but what of us sitting aloft the other ivory tower? How many of us have followed suit and shadowed a medical ethicist to become more ethically aware? Like many, I found medical ethics dry, removed and challenging as a medical student, but that doesn't detract from its overarching importance and I think that reflected my inexperience as a clinician and the format in which it was taught. I suggest a middle way, bringing together the twin towers of medicine and ethics, shadowing, working with and teaching each other. In the meantime can I recommend the free to use WMA's (World Medical Association) online tutorials in medical ethics which are excellent. http://www.legeforeningen.no/index.gan?id=147135. Competing interests: None declared |
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Kandappu Mylvaganam, Consultant Physician Luton & Dunstable NHS Trust LUTON LU40DZ, Dr Jo Balderamos Price
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Sir: Your track record is commendable and your raison d’être “to improve the moral trajectory of contemporary medical practices” an essential mission of Hospital (and Family Medicine) Services. A barometer of the moral climate in the hive of our clinical work is a desirable tool, and it behoves Trust managers to acquire one and mind it. Our Clinical Ethics Committee addresses contentious clinical issues, argues respectfully, and provides a consensus moral gauge, pointing the direction and clarifying position along a given trajectory.Multidisciplinary in composition with Statistician, Librarian, Nurse Manager and Social Worker and many doctors from wide ranging specialities, we work together.The result is not only better patient care but also flourishing interpersonal relationships, surely a far reaching improvement in our considered human condition. A distant vantage point often provides more accurate vision and another pair of trained eyes a better perspective, If the hat fits, wear it…there is no valid reason, why delivery of Healthcare of the highest ethical quality is the remit of a single group namely doctors. Is not the real issue relational? Competing interests: None declared |
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Tanu PramanikBSc.MA(Sociology), Faculty,Pre-Medical sciences Xavier University School of Medicine,Bonaire Netherlands Antilles, Prof (Dr) Jogenananda Pramanik.MD Faculty of Medicine,MAHSA College,Kuala Lumpur,Malaysia.
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We applauded the current ethical issues raised by Sokol D.K about doctors and ethicists for working together and to develop professional respects to each other (1).We strongly believe that our modern doctors are facing stringent ethical issues for which they were not trained during their medical course. It is always expected that they should grow up as an ethical doctor of their own. Medical ethicists coming with non-medical background fail to visualize the clinical condition at which doctors need to take instant decisions to save life. After the emergency life saving conditions are over, several unrelated issues are raised by medical ethicists which screw up the doctors who did his best to save life. Medical background knowledge is necessary to appreciate actual need of the hour. In modern medical practice most of the practitioners avoid taking high risk cases and always wait for the expensive investigation reports to be available to safe guard themselves. Medical malpractice insurance premiums are increasing and patients need to pay for it. Now doctors and ethicists antagonize each other sitting on the twin towers of medicine and ethics, while leaders of our society are looking for more stringent consumer protection act in favor of patients and doctors are preparing to seek their life jacket. In such situation, it is imperative that modern doctors need to have a firm grasp of ethical principles and an instinctive ethical mindset (2). “It is a failure to meet the accepted standard of medical practice”---is a term most commonly used by the medical ethicists to describe the decision of the ethical committee. On the other hand medical board often addresses them "But you’re not a doctor!" and your decision needs to evaluated further. In search of a far-sighted solution for such a long drawn controversy, we do also strongly recommend that we should decide to bring together the twin towers of medicine and ethics, shadowing, working with and teaching each other (3). Meanwhile, it is rightly pointed out earlier that most professional medical ethicists could not distinguish their "gluteus maximus from their lateral epicondyle" and it has been suggested that such ethicists should undergo a short clinical attachment (4). It is obvious that an ethical problem cannot easily be resolved if it has not been spotted and worked through in a structured way. Without the formal teaching and awareness of ethics, we may not have the understanding to make reasonable decisions in difficult circumstances. That is to make decisions that other reasonable people might have made in similar circumstance had they understood the detail of the issues. (5). Tanu Pramanik, BSc.MA ( Sociology ) Pre-Medical Sciences, Xavier
University School of Medicine, Bonaire Netherlands Antilles; and Prof (Dr)
Jogenananda Pramanik.MD Faculty of Medicine, MAHSA College, Kuala Lumpur,
Malaysia.
References: 1. Sokol D K. “But you are not a doctor”. BMJ 2008;337:a3077 2. Dr Mohamed Sakel We need “ethical” doctors! BMJ 2008; 337: a3077 (4 January 2009) 3. David R Warriner, A problem halved.... BMJ 2008; 337: a3077 (5 January 2009) 4.: Sokol D K :Ethicist on the ward round. BMJ 2007; 335:670 (29 September), doi:10.1136/bmj.39344.636076.59 5. Jonathan Howell :Recognising the ethical problem : BMJ 2007; 335: 670 (3 October 2007) Competing interests: None declared |
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