Managing medical treatments

THE practice of medicine is usually executed on the foundations of ethical professional practice. Professional means a member of any profession. In practice, it denotes the standards of education and training that prepare members of a profession with the particular skills and knowledge to perform the role as a professional.

Those who are specialists in that profession will have to perform at a much higher level. Doctors and specialists are assumed to perform within the set norms for the standard of care in medical practice. In addition, doctors need to patently adhere to acceptable ethical standards too.

Professional ethics encompasses the personal, organisational and corporate standards of behaviour expected of professionals in medical practice. Professionals exercise specialist knowledge and skills but medicine is not an exact science. Thus, medical professionals would exhibit various ways in managing a case.

While the profession may dictate the best mode of performing a certain procedure, ethics would seek answers as to why that’s the best way and whether it is justifiable by moral and ethical standards. These are the path plans doctors adopt when providing care to the patient.

Many medical organisations, academies and councils have chosen to formulate ethical professional practice to crystallise these ideas, thoughts and beliefs into setting the standards and paving the way for rational decision making in treating patients.

In Malaysia, the Malaysian Medical Council (MMC), the regulatory body for doctors, formulates ethical guidelines and “dictates” the way medicine is practised. Other medical bodies like the Malaysian Medical Association(MMA) play an advisory role to doctors on these matters. MMA does not regulate but would refer the matter to the MMC if there is an ethical indiscretion. This would be for the benefit of patients and doctors. The MMC or the MMA does not spare doctors if there is an infringement in ethics while providing medical care to patients.

Occasionally, market forces seem to influence how medicine is practised, however. Professionals seem to be pushed towards swaying away from the basics, as patients become more and more impressed and reliant on machines, gadgetry, diagnostic inventions and sophisticated non-invasive interventions to manage healthcare.

But are they really vital, or to be followed in a standardised manner to manage patients?

Is it fair for the patient to “demand” a series of investigations which are not needed or for a doctor to institute a panoply of investigations just to be safe?

Some of the “unnecessary” practices espoused have been due to doctors having to practise defensive medicine in view of rising litigation nationwide. But these are added burdens to the patient and additional responsibility to the doctor. In most cases, they are justified but the doctor is morally bound to explain the chosen path to the patient although it may be “riddled” with additional costs.

Some patients demand highly sophisticated surgery when simpler methods would suffice. Unwarranted hysterectomies (removal of uterus) are on the rise. Should Caesarian sections be done on demand? Patients seek the easy way out by choosing “painless” surgical procedures. They choose interventions rather than having to adjust to lifestyle modifications or long-term followup with medications.

However, doctors face a moral dilemma when acting out of need rather than necessity for the patient. It becomes a catastrophic experience to all if there is a misadventure following the chosen path demanded by patients. It is an ethical predicament that doctors would rather avoid but are being increasingly subjected to, however.

The primary obligation will be to cause no harm. When professionals provide this specialised service to the public, it is governed by generally acceptable moral and ethical values according to the general expectations of all and, most importantly, the patient. As professionals, doctors keep patient interest above all else.