“In my opinion, our health care system has failed when a doctor fails to treat an illness that is treatable.” – Kevin Alan Lee
I must confess that, during my pre-clinical years, I used to champ at the bit (a bit!) because of the several classes about “Medical Ethics”. “When would we get to the ‘real medicine’?”, I fretted. But in our classes now, during my clinical years, the doctors are still touching on some of those same points. This time around, the classes are having more of a positive impact, since I’ve actually had some time to experience working in the healthcare system.
Today I’d like to share a few thoughts on “the principle of social justice”. Now I know that some of you might be saying (with bitter memories of you or some close relative not being able to secure vitally needed medical care),”Say what?? Doctors and social justice in the same sentence?!”
But there it is. We’re taught that the medical profession must promote justice in the healthcare system — including the fair distribution of healthcare resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.
The way I see this is that, as doctors, we’ll be practising in healthcare systems at various levels of development. In Guyana, while my dad tells me that things have improved tremendously since he returned in 1990, the healthcare system is still far below Trinidad’s. Let’s hope our oil revenues will reverse that sad fact. But in the meantime, with whatever resource set we have at our disposal, we must be fair in our treatment to one and all. It does seem to me that our people are conditioned to defer to the “big ones” in society — and I suspect that doctors also do this.
One area we were cautioned about is the physician’s professional responsibility for appropriate allocation of perpetually limited resources — both the institutions’, especially governmental, and the patients’ finances. Doctors, then, should practise a scrupulous avoidance of superfluous tests and procedures, shouldn’t we? After all, the provision of unnecessary services not only exposes one’s patients to avoidable harm and expense, but also diminishes the resources available for others.
But from what I already have seen — both during my visits and readings about the U.S. Health system, and even in my native Guyana in a couple of private hospitals — there is a lot of over-prescription of tests. In the States, doctors may be doing this because of an overabundance of caution, from fear of being sued; but what’s the local excuse?? Making big bucks? While it may be a judgement call to assist in a better diagnosis, I do believe that a doctor should be aware of the social circumstances of the patient, and be prudent.
Overall, returning to a previous discussion I had about our more “socialised medicine” than that of the U.S., I am even more firmly committed to our system. And based on what we’ve always been taught at UWI, doctors also have a duty to work towards a medical system that is based on social justice. While I happen to believe in a “free enterprise system”, I believe that medical care falls into “public goods” that must be guaranteed by the state. And I am happy that in Guyana we spend such a large portion of our Budget on health. But we must insist we get the best value for our money.
The private medical care should supplement and augment that provided by the public system.
