ETHICAL ISSUES IN HOUSEMANSHIP

PROF ZABIDI – HUSSIN FRCPCH

CONSULTANT PAEDIATRICIAN AND PROFESSOR OF PAEDIATRICS

SCHOOL OF MEDICAL SCIENCES, UNIVERSITI SAINS MALAYSIA

dr.zabidi@gmail.com

zabidihussin@blogspot.com

LECTURE DELIVERED ON 11TH DEC 2010 UNIVERSITI SAINS MALAYSIA




· Ethics is linked to morality and judgments associated with it

· Everyone has his own moral values which has been nurtured over a period of time

· Every person’s moral values is unique and is normally determined by a number of factors including gender, culture, religious belief, environment and personal upbringing

· A medical student does not normally have an opportunity to exercise his moral judgment in dealing patient. Even if he does, that judgment does not influence the clinical management and care of his patient

· Ethical issues during period of studentship probably links to moral issues relevant to his personal conduct and its association to whosoever he in contact with. This may include issues such as truth telling, plagiarism, time-keeping, honesty, courtesy, empathy, respecting rights, communications and exploring insights of patients (MERCI checklist)

· Many of the issues of morality during the student days do not really matter to patient care

· The situation quickly changes as a student graduates

· Granting of a medical degree immediately empowers a student and unveils the cloak of uncertainty that has been covering him for at least 5 years

· He is now ready to make his own decision. Some of these decisions have to be made while he is at the front line of patient care, receiving patients at first point of contact and dealing with all the emotional issues surrounding a patient and his relatives

· This is the time when his moral judgments matter

· At the same time as he makes his judgments in his professional behaviour, his patients also judge him according to the scale of their moral judgments

· Judgment and evaluation of one’s moral standing can be gauged through a number of manifestations; from the way he dresses at work, the language he uses, gestures and body language, manner of interaction with peers and colleagues at work, note writings and phone calls and degree of urgencies in his actions. All of these carries significant weightage

· A patient who sees the first doctor on the scene who appears disheveled and unkempt would have a certain assumption and belief. Care of a sick person usually comes from an environment of clean and tidiness

· A houseman whose language lacks sufficient empathy and speaks in a language quite foreign to the patient he is in direct contact would transmit a certain message that can be adversely interpreted. Adverse interpretation may wrongly lack of interest and care, feeling of worthlessness, trust and confidence in the clinical management (remember the case of the doctor, declaring to his colleague that the hospital lacks fund, in full view of his acutely ill patient and his relatives). Casual statements such as “ I am only a houseman” or “My boss is not here and on holiday” would convey certain message to patients

· Patients normally take note the demeanor of the first doctor on the scene. Gestures and body language matter a great deal in transmitting sense of urgency and feeling of being taken care of. Most of these hidden issues relate directly to response to treatment and thus the speed of recovery from illness

· The environment within which a patient is being handled also carries significant value. Spilled bloods, and stained bed sheets, numerous indisposed used sharps would convey a situation of lacksidical approach to patient care, instill fear and reinforce negative values. A treatment room in full view of patient would also convey lack of sensitivity especially when painful procedures are carried out. An unnecessary large bandage over a small puncture mark would inevitably give a message that a big incision has been inflicted!

· A ward unguarded with laughter from doctors and health professionals would convey a sense of insensitivity and sometimes humiliation. This is especially true in situation of bereavement in an open ward

· A houseman is sometimes faced with ethical dilemma especially when his moral judgment may contradict that of his superiors. This can relate to issues in history-taking, physical findings and plan of clinical management. ( remember a case of a houseman who refuses to assist his consultant in a procedure as he feels that the procedure was unnecessary and unethical)

· Cultural and religious beliefs may also influence a houseman in his conduct. Care must be taken that these do not convey a negative connotation to his patient. Examples include statements such as “ I don’t work on certain days”, “ I am here now, even when I m not supposed to work”

· A houseman has to deal with colleagues (medical, nurses, support staff, administrators). His moral conduct will be transmitted to all those in contact with him. In an environment of close associates, judgments of others spreads quickly within an institution

· Ethical issues will also be relevant in dealing with those with financial interest in the clinical management of a patient ( insurance, pharmaceutical , companies dealing with equipments)

· Above all, the conduct of a houseman should exude a certain sense of flagship and icon for the medical profession, exhibit maturity and sensitivity that gives some reflection of humility between a care giver and those he cares for.





ZH

Dec 2010