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Monday, May 1, 2006

Physicians Heal Ourselves


Dr. Lester CN Simon

And I saw, and behold a white horse: and he that sat on him had a bow; and a crown was given unto him: and he went forth conquering, and to conquer. (Revelation 6:2).

Medical professionalism in Antigua and Barbuda is under attack. The battle began many years ago but the freeing up of national radio is bringing the frontline of the battle to the streets of the city with embedded journalists and all.

When I am confronted by a medical problem I cannot solve, my profession teaches me to consult my elders and resort to the medical archives.

The November 18, 1999 edition of The New England Journal of Medicine carries an article entitled, Medical Professionalism in Society, by Matthew K. Wynia, et al. It reminds us that the word, “profession” means, from the Latin, “speaking forth”. The authors put out a model of medical professionalism that comprises three core elements: devotion to medical service, public profession of values, and negotiation regarding professional value and other social values.

Whenever a doctor reflects on the harrowing years in medical school, two overwhelming emotions underscore those challenging years. We all remember the strong desire of be invited in, to be inducted and welcomed into the fraternity of noble men and women dedicated to the noble art and science of healing. We also recall the satisfying feeling of arrival, of actually becoming a doctor and being charged with the responsibility of doing battle against the evil forces of sickness and untimely death.

I have always wondered what is so unique about belonging to a fraternity of doctors, especially since we do not fraternise as often as we should, and, quite frankly, some of us would oftentimes prefer to socially engage other members of society. Wynia et al answer by suggesting that professionalism is a structurally stabilizing, morally protective force in society. The authors posited the triumvirate of private-sector, public-sector and professionalism as the cornerstone of a stable society.

It must be noted that the professional side of this stable, social triumvirate is both constant and manifold. Professionalism is not exclusively medical; it includes other professions and it embraces civil society.

According to Wynia et al, the first core element of medical professionalism is devotion to medical service. They remind us that physicians should cultivate in themselves and in their peers a devotion to health care values by placing the goals of patients and public health ahead of other goals. In Antigua and Barbuda, as elsewhere, this cultivation must grow out of a functional association of doctors in which we criticize and police one another. This core element of medical professionalism is so important, the authors arrive at a telling admonition.

They charge that devotion to medical service is so important, physicians must avoid even the appearance that they are primarily devoted to their own interest rather than to the interest of others. Patients in vulnerable times of need of medical service may be easily confused, used and abused in this regard. It behoves the members of the medical profession to profess, to speak forth.

The second core element of medical professionalism, the speaking forth must be done from a moral, ethical and professional base otherwise individualistic ranting becomes a big boast and an ugly, cheap, self-defeating marketing tool.

The third core element involves balancing medical needs with other societal needs as it allows other arms of the multiplex, professional bodies and the rest of the triumvirate to jostle and sway and engage in battle. The non-negotiable tenet, the sine qua non of this romantic war must be that the triumvirate forces of professionalism (including civil society), private-sector and public-sector must always underpin and rigidly stake society to the ground. Those who deliberately seek to destroy the underpinning of Antigua and Barbuda society are seeking long-term residence at the east of the Antigua Recreation Grounds.

So if you know all these things and you see any young, medical warrior return home brimming with enthusiasm, confidence and self-righteousness to do battle against sickness and untimely death, it is the sacred duty of the you the elders to temper and guide the misguided youth, curb the enthusiasm and distil the natural effervescence of the neophyte. And when the youth throws a tantrum and rants and raves and misbehaves, it is the sacred duty of the elders to remind: When I was a child, I spake as a child, I understood as a child, I thought as a child: but when I became a man, I put away childish things (First Corinthians, 13:11).

Verily, it cannot be acceptable that the former elders of society wantonly, barefacedly and wittingly allowed a young medical warrior to marginalize and alienate himself and then shout at the new elders and remind them that they, the new elders, proclaimed before they became the new elders that “What is wrong will be made right”. This kind of thing will make Jesus bawl, as in the Gospel According to Saint John, 11:35.

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