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Do Oaths and Rules Make a "Good" Doctor?
Do oaths and rules make an ethical and caring physician?
In the realistic and present day world of medical practice, the way medicine is practiced both in terms of emphasis or de-emphasis of oaths, medical school teachings and established legal and professional requirements are going to be different between one physician and another. There are going to be shortcuts and at times excesses depending on the situation and even the mood of the physician. Doctors are going to take chances or they will strictly follow what they believe are standard operating procedures ("standards of practice"). Yes, the Oaths are there, the laws and professional requirements and all the tools for professional behavior as provided by the medical schools are there but in the end, each doctor in their own professional environment will obey them as they see fit at the time. And it is up to their patients and their colleagues to finally grade the doctor.
Do oaths and rules make an ethical and caring physician? My conclusion is "probably not". I think it takes more than that. And, if you agree, what "more" is necessary? Let's read your thoughts on the subject. .Maurice.
5 Comments:
Dr. Bernstein, you're right - it takes much more.
This, in my experience, is what makes a good doctor: Every time I leave my primary care's office, I feel as if whatever comes up, I know that he and I together will make the absolute best of it possible. I can walk in with very troubled thoughts, and walk out feeling as if someone actually understood what I was saying, and is just as interested as I am in making things better in whatever way necessary.
Patients know the difference when they have a physician who is "just doing a job" vs one who is "living a vocation".
Dr. Bernstein, I hope that your New Year is peaceful, healthy, and full of good times! :o)
Moofie, just a bit of a personal question but relative to your good experience with your personal physician: Did you obtain purely "introductory visits" (no personal medical issues discussed except wanting to get to know the doctor) with you doctor or other doctors? What do you think of the importance or value of such a visit if it can be accomplished? ..Maurice. p.s.- thanks for the New Year wishes.
Dr. Bernstein, thanks for the opportunity to elaborate.
The first appointment I had with him ended up being a "getting acquainted" visit, and it worked very well. I had a chance to ask him all sorts of questions about himself, and he also had an opportunity to see what he was tackling. When I actually came back for a medical visit - which was within a week of the introductory visit - he and I were both more comfortable with each other. He had an idea of what my issues were, and I had an idea of how he would react to my questions and comments.
It's gone a long way toward providing trust between the two of us ... and it's been far easier for me to be forthcoming with him. I've never had quite the same experience with any another physician.
The idea of actually "getting acquainted" with a doctor before choosing him as your personal physician gives both of you the opportunity to evaluate whether you think the relationship will work. As the "delivery method" of medicine becomes more fractured, the feeling of trust and continuity with a primary care physician becomes all the more important.
Hopefully, that addressed some of your questions. If not - please let me know, and I'd be happy to respond.
Moofie, in this introductory visit, what facts would you like to know about your "possible doctor to-be"?
Would it be more about his or her academic or professional background and experience? Or would it be more about his or her personal life and religion and philosophies and how they were similar to your experiences or religion? Or with regard to personal life, for example, would it be helpful to know and would you ask about the illnesses faced by the "doctor to-be" him/herself or in the family and how they were handled or should have been handled? Would you be more attentive to observe how the physician responds to you in terms of eye contact,attention,body language and the way he or she responds to your questions? Or would the responses to the personal issues of your concern be the most important such as, for example, how he or she would handle any physical modesty issues you may have, managing his or her office, financial matters, responding to phone calls or punctuality? Would you be also comparing this doctor with ones you have had in the past?
What I am asking is more specifically regarding, in this introductory, getting acquainted, meeting how you judge that you would be attended by a "good" doctor and one who would treat you as one "living a vocation" rather than merely "doing a job". ..Maurice.
Oaths and rules create an ethical framework in which a physician ought to practice. Per Kant, I would will that physicians universally practice according to traditional medical oaths and rules or guidelines for conduct. That this is not the case is all too evident when one interacts with the health care system.
From the physician’s standpoint, endless requests for documentation from third party payers are onerous in the extreme. The physician is no longer able to implement her clinical judgment as she sees fit. Her decision-making will only be approved (i.e., she will only get paid) if her treatment fulfills criteria of evidence-based guidelines. The amount of time these processes consumes is huge. Time available for actual patient interaction is vanishingly brief.
But from the patient side, don’t we want our doctors to utilize best practices? When we consider the awesome waste and inefficiency of the U.S. health care “system”, we understand it is long past time to continue to permit utilization of procedures that are not demonstrably effective.
In terms of oaths, if the physician’s guiding principle is anything different from “do no harm”, every one of his patients is in deep trouble. If the physician’s main reason for being a physician is anything other than a deep desire and intention to be of service to his patients, then he is merely a businessman who has chosen the business of medicine.
Of course, many if not most of the physicians we encounter today in our search for a good doctor are businesspersons first. We don’t have to look far to explain our national health care expenditures of $2.5 trillion in 2009.
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