No physician, however
conscientious or careful, can tell what day or hour he may be the object of
some undeserved attack, malicious accusation, blackmail or a lawsuit for
damages. It’s happening more and more- doctors being assaulted by
patients or their relatives. A hospital is supposed to be a sanctuary, a place
where people come for care at the most troubling times, where we seek safety
and reassurance. Those needing such care greatly depend on the doctor and his
support staff. Doctors strive to be impartial caregivers for everybody, to be
the shining examples of humanitarian service and self-sacrifice. Doctors have
traditionally enjoyed an unassailable halo, a mixture of healer, advisor and
confessor. Doctors have been appropriately bestowed with a higher degree of
trust than most members of society. These senseless acts of vandalism serve as
a metaphor for the potential decay of a profession.
Today’s health care system
is being transformed into a chaotic one because people tend to view the system
as too expensive, dysfunctional, and at times, irrational. The regulatory and
financial burdens placed on doctors can result in long wait times and short “face
times” with patients. The high expectations raised by the latest medical
technology can be shattered in individual cases. Frustrations can reach the
boiling point for some people, and the doctors or their clinics offices are not
immune to them.
A doctor is often an object
of strong feelings, both positive and negative. A patient may view him as a saviour, God or a magician. Yet to some, he may be the symbol of a system
gone wrong, if not the tool of one’s particular suffering. Violence stems from
the complex dynamics of a given individual’s specific situation. Violence can
be a flash reaction to frustrating helplessness, fear or humiliation. A doctor’s
unique role may make him an iconic, visible scapegoat for health care’s
failings, particularly now as his stature is being eroded by a combination of
external forces and some of his own making.
The traditionally autonomous
doctors, once independent operators of medical service, are becoming line
workers in large systems. Majority of freshly passed ones choose employment, as
opposed to private practice, given the daunting regulations and financial
pressures. Though valued and trained members of the health care team, in many
cases these doctors lack the privileges of performing high skill procedures,
thus limiting their competence.
Additionally, the internet
has turned everyone into a doctor. Patients come to doctors armed with
downloaded material targeting their condition, challenging the value of the
doctor’s knowledge. Lawyers also tend to do so regularly, to find a
loophole in the procedure performed by the doctor so as to nail them, even if
it was an exception made by the doctor, seeing the patient’s condition.
This devaluation of the
profession of medicine is of some societal concern. Physicians are
professionals not simply because they get paid. Sociology, the social
science that studies human interactions, organization, and institutions,
defines a profession as an occupation which regulates itself through
systematic, required training, and collegial discipline. A profession’s
validated knowledge and competence is continually validated by the community of
peers, and its continuing education standards. Perhaps most importantly, that
professional knowledge results in judgment, advice, and actions oriented
towards a set of substantive societal values, which is health and well-being in
the case of medicine. Service rather than profit is enshrined in its code
of ethics.
Hence the profession is
cognitive, collegial, and moral. Because of this process of
legitimization, doctors achieve a coveted status of professional authority,
which is a valuable asset. It increases the probability that people will
obey a legitimate command or call to action and that a particular definition of
reality and judgment of meaning and value will prevail as valid and true.
For example, a person heeds a doctor’s warnings about smoking, taking needed
medication, vaccinations for personal and societal benefit. A doctor’s
authority also creates a dependency condition. Patients acknowledge the
professional’s superior competence within a deep context of emotional and
physical needs in the doctor-patient relationship. A component of this
dependency condition actually promotes therapeutic success. Therefore,
professional authority is worth preserving and nurturing.
When a doctor abuses his
professional authority, he contributes to the profession’s devaluation.
Medical education is expensive, with the doctors training for years, sacrificing
early paychecks, and missing family time to attain and maintain the ideals of
their calling. A false sense of entitlement in some is understandable.
Some may define themselves as professional simply as being paid for their
service, and define professional success in financial terms. Clearly, the
transformation of health care poses challenges for most doctors, and threatens
to commercialize their specialized core assets. Sensing an increasing
loss of control, a growing frustration with their redefined industrialized
role, it is easy for doctors striving to maintain the true ideals of their
profession to become disillusioned, if not downright cynical. Cynicism
can corrode all human values and can also corrode the values of a profession.
One cannot prevent precious
loss of life of a patient in all the situations, and no doctor actually wants
to do harm to his patient, or bring himself disrepute. Doctors, as well as
policy makers and patients, should strive to sensibly prevent a noble
profession’s pernicious loss of its cognitive, collegial and moral value
system, a thing that is precious to one and all.
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