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doctors

Not Everything Need Be Transparent

by Dr.Mani on April 30, 2011

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Seth Godin comes up with brilliant marketing concepts.

But at times, I find myself on the opposite side of the fence with his opinions.

This is one such instance – primarily because of the choice of his examples. In his recent post, “Why you might choose to be in favor of transparency“, Seth refers to:

1. Why doctors should encourage transparency in their results.

2. An Indian bureaucrat’s argument in favor of legalizing bribery in some instances.

The variable being ignored or brushed aside, in this over-simplification of what is in reality a rather intricate and involved interaction of ‘action’ and ‘reaction’, is the dynamic impact transparency (or the risk thereof) can have upon the action being performed itself.

A surgeon whose operation is transmitted live to a patient’s family sitting outside the O.R. (something that’s technically possible) is bound to be nervous and jittery, even to a point where he may make more mistakes or errors of judgment.

‘Anonymous’ transparency, as when an institution reveals aggregate data of medical performance statistics, is free of this effect.

As is internally audited information that is initially perused only by competent and qualified experts who know how to interpret the technical data.

Most hospital departments have weekly or monthly audits to monitor performance, even sub-stratified by specialty or individual practitioner. But this is NOT made public – for good reason!

When patients post reviews, they are conditioned and influenced (not unreasonably) by emotion, personal feelings and incomplete technical knowledge. Having that in the public domain, where it may adversely impact the general perception of a highly skilled and qualified technical specialist, isn’t quite good practice.

How many of us are competent to judge intricate economic decision-making, or the rightness of protocols to shut down nuclear plants in a melt-down situation, or merits and drawbacks of a cutting-edge technological innovation like stem-cell therapy, or cloning, or nano-tech?

Not many. In fact, precious few. Yet transparency in these processes is being called “desirable”.

Exactly why?

‘Empowerment’ is not making data available willy-nilly – but more of allowing access to it by qualified experts who are able to make sense of it.

The paper by the Indian bureaucrat is intriguing… though also whimsical.

In this instance, it is presumed that the bribe-taker has ethical standards, and will cringe or worry about being outed in his bribe-taking. Reality, though, is different. Everybody concerned KNOWS already that these folks are taking bribes. It isn’t as if making this information public will change much, if anything at all.

And the bribe-taker knows it’s possible to bribe one’s way out of being prosecuted – unless you’re small fry! See this interesting cartoon from a recent issue of ‘The Hindu’.

The risk, then, of being too transparent, is that you become invisible!

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Doctors Are Human

by Dr.Mani on June 25, 2009

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Dr.Srinath Reddy intelligently and intellectually analyses what’s wrong with medical education in India in his editorial in THE HINDU – The missing ‘E’s of medical education. But, perhaps naively, he has ignored something important – the HUMAN element!

Most, if not all, doctors practicing medicine know that a battery of tests often serves no real benefit in terms of diagnosis of an ailment. But they do know that it translates into an economic advantage, direct or indirect, which is the reason why it keeps being done. Avarice, not ignorance, is the driving force.

Equally romantic is the idea of ‘teaching’ empathy to a medical student. It is not like trying to teach ‘obedience’ or ‘honesty’ (which are behaviours) to a school boy, but like trying to inculcate ‘love’ or ‘concern’ or ‘affection’ (which are emotions) in a grown-up.

One is born with them (or grows up in early childhood developing them) – or one doesn’t.

And when the seed of these emotions lie inside, it is almost impossible to deal with human suffering as a clinician without being deeply touched by the emotional roller-coaster that any doctor rides each day in professional life. (See “Doctors Die a Little Every Day“)

Medical practitioners who function as highly skilled automatons are a reality of any country, or form of medical education for this very reason.

Some refine their skill set, while dulling and walling off their feelings, as a protective barrier that permits efficiently carrying out their duties. Others refuse to get involved and deeply engaged with their patients, more as a reflection of their personality and nature, rather than their medical training.

I also take strong exception to the blanket statement that ethical role models are non-existent. I have personally been influenced by the high ethical standards of many of my own professors and teachers, like Dr.A.M.Selvaraj, Dr.V.G.Tapase and many more, and have tried, in my own practice, to be one for my students who choose to follow and model me.

While there are many good points in Dr.Srinath’s editorial, especially in the area of imparting epidemiological knowledge to Indian medical students, in the end what will make them better doctors has less to do with what they are formally taught in college, and more to do with what kind of people they essentially are.

Empathy is a noble human emotion. Avarice is an ignoble human emotion. And doctors have both. Because doctors are, after all, human.

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