PAKISTAN Medical Association at a recently concluded seminar on medical ethics stressed upon the medical fraternity to look into the weaknesses in the health delivery system and malpractice in the profession.
Participants had divided opinion on the ethical standards for professionals. They put physicians and surgeons in one category, pharmacists in the second pathologists in the third and paramedical personnel in the fourth category. The role of pharmaceutical industry was also discussed.
These categorisations were made to facilitate focussed discussion on the conduct of all those who combine together to deliver health care services to both healthy as well as ailing people.
The seminar highlighted the ineffectiveness of the government, which has failed to regulate medical practice, enforce discipline in the registration of physicians and surgeons, pathological laboratories and diagnostic centers, blood collection and distribution units.
Though private practice has always been encouraged in Pakistan and the institution of family physicians has been playing a vital role in providing adequate health care services to people at minimal cost but in recent years it has assumed a different role. Expensive consultants who run their clinics purely on commercial lines have replaced the clinics of family physicians, a source of dependable and affordable medical care.
Combined with ills in the health care system are prices of medicines that have gone up and charges of diagnostic laboratories that were within reach have almost doubled faster than the prices of medicines. There seems to be complete anarchy in the health care system and all standards of medical ethics have been made redundant.
For argument sake let us pick up any code of conduct and examine the existing situation in its light. It is to be remembered that basic contents of medical ethics are same in different countries.
For example Principles of medical ethics as laid down by the America Medical Association says that a physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. Whereas, in Pakistan the situation is contrary to this principle. Numerous cases of quackery have been reported where qualified doctors are found indulging into unhealthy practices. Administration of distilled water injections, wide scale distribution of antibiotics and indiscriminate use of cortisone is rampant in suburban and rural Pakistan. Medical professionals are found involved in these unhealthy practices.
1. The code of ethics says that a physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. Whereas in Pakistan reports are filed with Pakistan Medical and Dental Council that medical practitioners have misused personal information gathered from patients and subsequently used it for blackmailing them
2. A physician shall respect the law and also recognise his/her responsibility to seek changes in those requirements, which are contrary to the best interests of the patient. Whereas the situation in Pakistan is contrary to this principle.
3. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patients' confidences and privacy within the constraints of the law. In Pakistan there is no such law that provides protection to patients where their rights to have safe, competent and adequate medical facility is infringed and subsequently restored through legal procedure.
4. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated. In the first place in Pakistan there is no concept of continuing medical education, periodic on job training, facilities for research and centralised collection and dissemination of updated knowledge on medical issues.
It is seldom seen that medical practitioners following same discipline are in contact with each other, arrange group discussions and exchange information on issues concerning their specialities.
5. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care. This concept of medical ethics is new to Pakistan as it provides freedom to act and freedom to take decisions in the interest of patinas. In the opinion of medical practitioners this kind of freedom to act would come to Pakistani doctors only in a highly developed medical care system. Since in Pakistan only about 25 to 30 percent population has access to 'some kind' of medical facility therefore options, freewill and application of discretion in the interest of patients are limited. To give freedom to a doctor so that he/she could take decisions in the interest of patients, irrespective of its consequences, seems to be a distant possibility in Pakistan.
6. A physician shall recognise a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. In Pakistan there is some realisation of this need. Some of the leading NGOs and teaching hospitals in the private sectors have established their units in rural areas where health care facilities are scares. However, the pharmaceutical companies have not supported the popularisation of this concept for preventive needs. Their products are available on the market with great difficulty. For example diabetes, kidney diseases, blood pressure and heart ailments are some of those problems that require lifetime medication. Medicines, which are lifesaving or are to be taken by a patient for his/her entire life, are expensive. For pharmaceuticals lifetime users of medicines provide them 'captive buyers'.
7. A physician shall, while caring for a patient, regard responsibility to the patient as paramount and shall support access to medical care for all people. This is altogether an alien idea for health care professionals in Pakistan. This realisation is possible only in a non-commercial environment only.
In America and Europe where health care is expensive and is available through insurance but strangely people get it at affordable price. There is a correlation between health care system and medical ethics. In Pakistan a close study of this correlation if carried out would give an opportunity to analyse flaws in the existing health care system, help find out solutions and evolve ethical standard to regulate medical practice, working of pathological laboratories, diagnostic centers and functioning of pharmaceuticals. Once a system has been developed it should be given legal cover so that no one outrages its modesty. But who would do it?