Observations Ethics Man

We must do more for doctors trained abroad

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4837 (Published 03 November 2010) Cite this as: BMJ 2010;341:c4837
  1. Daniel K Sokol, honorary senior lecturer in medical ethics, Imperial College London
  1. daniel.sokol{at}talk21.com

The patient had a crown of plum sized abscesses on his head. After a brief exchange the doctor started screaming at the patient. It was an old fashioned telling off. The outburst over, the patient hurried out of the consultation room. Later that morning he returned, his head shorn of hair offered to some Hindu deity and revealing some unsightly lunar landscape of mounds and craters. The doctor proceeded to drain the abscesses. The look of agony on the patient as the scissors dug deep into his scalp will stay with me for ever. “Would some anaesthetic be helpful?” I suggested to the surgeon, gingerly, as I pinned down the patient’s legs. “I won’t give him any unless he says it’s intolerable. Western doctors give too much anaesthetic.” The patient, writhing in pain, didn’t utter a word.

I often wondered what would become of the doctors I befriended in rural India if they were to work in the United Kingdom. The principle of respect for autonomy, so dominant back home, held little weight there. The doctors acted as the decision makers in a patient population that was largely illiterate and medically unsophisticated. In a semblance of consent the …

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