I am back again.. And this time I will attempt to dissect the facts on why should we trust a doctor.. I will not elaborate any further on why I am doing this three-chapter series, however I do hope that after this roller-coaster ride is over, my dear readers will have a stand, or at least a strong reason to entrust their lives in the hand of a doctor, or certainly otherwise..
History - The Ultimate Reason?
History is one tool that could be used to strengthen a belief, or even be used to negate a belief.. For a profession such as a doctor, history is certainly a strong point to bring up in any discussion..
Every person in the world knows that this profession has lived in the lives of mankind for so many years, certainly the undocumented history tracks back even longer.. Several names such as Avicenna (Ibnu Sina) and Hippocrates are among the famous ones written in history.. Even at this level, we are talking at the time around 370 BC.. For some cultures and ethnic groups, witch-doctors are the equivalent to the community general practitioners..
This is from a wide historical perspective..
Looking at a smaller scale, it is not uncommon for a person to return to their 'favourite' doctor everytime they are unwell.. The trust and rapport that has been built between the doctor and the patient is a strong 'historical' advantage to any doctor.. Of course, along the way, the doctor then becomes more and more familiar of the patient's medical background, the medications he is on and the small bits and pieces of the medical history, having taken them in depth at initial contact.. We often hear :
"He's a very good doctor.. He knows the best tablets for my pneumonia."
"I always go back to her.. She's very gentle to me and my children.."
"He's the best doctor.. He remembers all my details and knows all my health problems.."
"I always go back to her.. She's very gentle to me and my children.."
"He's the best doctor.. He remembers all my details and knows all my health problems.."
The trust was built between the doctor and a patient holds a very significant bond that you would actually literally trust your life to him.. This is not unusual, in fact, that even outside his surgery practice, we still consult to a doctor, not just about our health, but also about our day-to-day issues unrelated to medicine.. Why do we do this? Is a doctor worth that much of our trust? The answer is in the history - whether it comes from our reading telling us about the intelligence and superiority of mind of the doctors, or from our personal experience knowing a doctor and having a contact with him.. History has ultimately provided us a massive platform to stand on even before we gain any trust on a new doctor we never actually met before..
Take a moment to evaluate this scenario : You feel unwell and you present yourself at the hospital.. You don't even know the doctor working that night, but subconsciously you have already decided that you will entrust this unknown doctor to 'fix' you and make you feel better.. Where is the logical explanation in that? The answer in none.. Just trust.. As you always had, as you always have..
Hippocratic Oath And Primum Non Nocere
A sacred transcript from many years ago guiding doctors in practice pertaining to the morality and ethics in their service.. As we know by now, Hippocrates was a great Greek physician around the year 370 BC.. Indeed, the Hippocratic Oath was named after him.. The modern version of the Hippocratic Oath was written by Dr Louis Lasagna (1923-2003) in 1964.. The oath is still at least a ceremonial salutation for newly-graduates of medical school all around the world before being released in the 'real' practicing world of medicine.. The fact that this oath is not a compulsory exclamation for all doctors does not by any means translate to not adhering to the code of conduct outlined in the oath.. Certainly, despite the lack of us hearing the oath being religiously and formally performed in every medical conferences or physician gatherings, the spirit of holding to a conduct and ethical value within the practice of medicine is until today a must and now a second nature to all doctors..
On the other hand, the Latin phrase Primum Non Nocere literally translates to 'First, do no harm'.. For this phrase, the history behind it is still of uncertainty.. Some believe that this phrase is of the work of Galen, a protege of Hippocrates.. However, this does not explain the phrase being in Latin rather than in Greek.. Also, contrary to popular belief, this phrase is not in the Hippocratic Oath.. To explain the significance of this simple Latin phrase is not a hard effort altogether.. It is significantly self-explanatory : First, do no harm.. As simple as that.. Behind all the logic and simplicity, it is not at all an easy practice to do no harm in the first instance..
Worldwide community expect the doctor to 'do something' about them when they present to a hospital.. More often than not, acutely unwell person will have the 'do something' they search for.. An easy example would be presenting with a urinary tract infection.. The patient will expect the doctor to prescribe paracetamol to control the fever, an anti-sickness to manage the nausea, and an antibiotic to clear the infection.. However, medical practice has developed so widely and deeply that the dilemma to an attending physician is no more as straight-forward as a simple infection case.. Consider a lady presenting with a breast lump.. An ultrasound is booked and reveals suspicion of a tumour.. After deliberate discussion and consent, a biopsy was taken proving the sinister presence of the tumour.. A further workup is done with a CT scan and reveals presence of tumour in multiple organ sites.. At this stage, very minimal harm had been done apart from a needle biopsy.. But the next question is : Do we start chemotherapy? Do we offer surgery? The answer now is no longer available in any textbooks.. The dilemma is what will doing all these treatments result? Putting through a person under the scalpel is not without its risks - anaesthetic complications, surgical complications, cosmetic changes to the lady.. Is the answer for surgery 'No' or 'Go'? What about chemotherapy? Immune suppression is well-documented in all trials with cytotoxic chemotherapy, regardless of combination therapy.. Hair loss, nausea and vomiting, feeling lethargic after treatment - all are harmful.. So, do you expect doctors to make the decision for you? Most of you would expect so.. And the burden is back to the doctor - first, do no harm.. If, on the balance of treating versus not treating favours treatment with a (for example) survival benefit of 18 months, then the agreed decision would be a 'go ahead' despite the casualties of medication-induced side effects.. If not in favour, then why torment a person to such gruesome side effects of medication when the outcome is invariably dismal?
Always remember the next time you see a doctor : He has a code in his practice, a guide he holds strong to, and a reservation to not harm..
The Good One In, The Good One Out
People has long believed in a doctor even before they remember seeing one.. Obviously enough, the title 'Doctor' is a label hard to discredit even during out of working hours.. This phenomenon is not unusual, especially in the Malaysian community.. Even during weekends, when a doctor wishes to spend his time with his family, there would be phone calls from an anxious mother asking him about what to do with a feverish boy, merely because the mother is good friends with the doctor's wife.. Unwilling to be harsh and arrogant, the doctor leaves his family, goes to the boy's home and examines him and even possibly sends him to a nearby clinic..
Such a trust to a doctor to the extend that he is a doctor despite the hours.. He is not anymore perceived as a husband, father or just an ordinary man.. He is a doctor - full-time, full stop! People call other people by their first names in the community, but by no means it goes the same to a doctor.. He is referred as 'Doctor', in the village, in the supermarket or at the petrol station.. The noble seat being granted to a doctor outside his practice is huge..
Does the title bring so much respect and declares so much intelligence to the bearer of a scroll from a medical school? I believe the respect comes with the title so much more than it does from the person himself.. I believe the title, in some way, re-defined intelligence, that a doctor is perceived as the all-knowing of all areas, not just in medicine.. And this is true as we can testify how many times we have asked a doctor for his opinion to such an issue totally unrelated to medicine.. And we refer to him for our psychological needs and even spiritual supports..
The doctor is seen not just as the good one in the hospital, but also as the good one outside his working hours.. He may well have the character and personality in keeping with his code of practice as per Hippocratic Oath, he may well have been historically good to you treating your child's fever.. Inevitably, we still see him as a nobility in the community and an expert in his career..
So Many Reasons To Trust
As I have laid to you the reasonable reasons for trusting a doctor, I am almost certain that the examples I have given can well relate to our daily lives.. As I conclude this second part of the series, I believe I have given enough reason to justify doubting a doctor (in Part 1) and indeed subsequently debated convincingly on why to trust one..
The next chapter, the last entry of the series, will be a dissection of a doctor's daily life under a microscope - laying to you the working hours, the environment of working and the difficulties of doctors face everyday to ensure that they hold to the trust given to them by the patients but not jeopardising the care just because of the reasons and possible propaganda working against them.. At this stage, your views should be somewhat balanced with enough reason to trust and not to trust.. The final episode will then decide whether you tip to the trusting pack or otherwise..
Till we meet again soon.. Salam..
Take a moment to evaluate this scenario : You feel unwell and you present yourself at the hospital.. You don't even know the doctor working that night, but subconsciously you have already decided that you will entrust this unknown doctor to 'fix' you and make you feel better.. Where is the logical explanation in that? The answer in none.. Just trust.. As you always had, as you always have..
Hippocratic Oath And Primum Non Nocere
A sacred transcript from many years ago guiding doctors in practice pertaining to the morality and ethics in their service.. As we know by now, Hippocrates was a great Greek physician around the year 370 BC.. Indeed, the Hippocratic Oath was named after him.. The modern version of the Hippocratic Oath was written by Dr Louis Lasagna (1923-2003) in 1964.. The oath is still at least a ceremonial salutation for newly-graduates of medical school all around the world before being released in the 'real' practicing world of medicine.. The fact that this oath is not a compulsory exclamation for all doctors does not by any means translate to not adhering to the code of conduct outlined in the oath.. Certainly, despite the lack of us hearing the oath being religiously and formally performed in every medical conferences or physician gatherings, the spirit of holding to a conduct and ethical value within the practice of medicine is until today a must and now a second nature to all doctors..
On the other hand, the Latin phrase Primum Non Nocere literally translates to 'First, do no harm'.. For this phrase, the history behind it is still of uncertainty.. Some believe that this phrase is of the work of Galen, a protege of Hippocrates.. However, this does not explain the phrase being in Latin rather than in Greek.. Also, contrary to popular belief, this phrase is not in the Hippocratic Oath.. To explain the significance of this simple Latin phrase is not a hard effort altogether.. It is significantly self-explanatory : First, do no harm.. As simple as that.. Behind all the logic and simplicity, it is not at all an easy practice to do no harm in the first instance..
Worldwide community expect the doctor to 'do something' about them when they present to a hospital.. More often than not, acutely unwell person will have the 'do something' they search for.. An easy example would be presenting with a urinary tract infection.. The patient will expect the doctor to prescribe paracetamol to control the fever, an anti-sickness to manage the nausea, and an antibiotic to clear the infection.. However, medical practice has developed so widely and deeply that the dilemma to an attending physician is no more as straight-forward as a simple infection case.. Consider a lady presenting with a breast lump.. An ultrasound is booked and reveals suspicion of a tumour.. After deliberate discussion and consent, a biopsy was taken proving the sinister presence of the tumour.. A further workup is done with a CT scan and reveals presence of tumour in multiple organ sites.. At this stage, very minimal harm had been done apart from a needle biopsy.. But the next question is : Do we start chemotherapy? Do we offer surgery? The answer now is no longer available in any textbooks.. The dilemma is what will doing all these treatments result? Putting through a person under the scalpel is not without its risks - anaesthetic complications, surgical complications, cosmetic changes to the lady.. Is the answer for surgery 'No' or 'Go'? What about chemotherapy? Immune suppression is well-documented in all trials with cytotoxic chemotherapy, regardless of combination therapy.. Hair loss, nausea and vomiting, feeling lethargic after treatment - all are harmful.. So, do you expect doctors to make the decision for you? Most of you would expect so.. And the burden is back to the doctor - first, do no harm.. If, on the balance of treating versus not treating favours treatment with a (for example) survival benefit of 18 months, then the agreed decision would be a 'go ahead' despite the casualties of medication-induced side effects.. If not in favour, then why torment a person to such gruesome side effects of medication when the outcome is invariably dismal?Always remember the next time you see a doctor : He has a code in his practice, a guide he holds strong to, and a reservation to not harm..
The Good One In, The Good One Out
People has long believed in a doctor even before they remember seeing one.. Obviously enough, the title 'Doctor' is a label hard to discredit even during out of working hours.. This phenomenon is not unusual, especially in the Malaysian community.. Even during weekends, when a doctor wishes to spend his time with his family, there would be phone calls from an anxious mother asking him about what to do with a feverish boy, merely because the mother is good friends with the doctor's wife.. Unwilling to be harsh and arrogant, the doctor leaves his family, goes to the boy's home and examines him and even possibly sends him to a nearby clinic..Such a trust to a doctor to the extend that he is a doctor despite the hours.. He is not anymore perceived as a husband, father or just an ordinary man.. He is a doctor - full-time, full stop! People call other people by their first names in the community, but by no means it goes the same to a doctor.. He is referred as 'Doctor', in the village, in the supermarket or at the petrol station.. The noble seat being granted to a doctor outside his practice is huge..
Does the title bring so much respect and declares so much intelligence to the bearer of a scroll from a medical school? I believe the respect comes with the title so much more than it does from the person himself.. I believe the title, in some way, re-defined intelligence, that a doctor is perceived as the all-knowing of all areas, not just in medicine.. And this is true as we can testify how many times we have asked a doctor for his opinion to such an issue totally unrelated to medicine.. And we refer to him for our psychological needs and even spiritual supports..
The doctor is seen not just as the good one in the hospital, but also as the good one outside his working hours.. He may well have the character and personality in keeping with his code of practice as per Hippocratic Oath, he may well have been historically good to you treating your child's fever.. Inevitably, we still see him as a nobility in the community and an expert in his career..
So Many Reasons To Trust
As I have laid to you the reasonable reasons for trusting a doctor, I am almost certain that the examples I have given can well relate to our daily lives.. As I conclude this second part of the series, I believe I have given enough reason to justify doubting a doctor (in Part 1) and indeed subsequently debated convincingly on why to trust one..
The next chapter, the last entry of the series, will be a dissection of a doctor's daily life under a microscope - laying to you the working hours, the environment of working and the difficulties of doctors face everyday to ensure that they hold to the trust given to them by the patients but not jeopardising the care just because of the reasons and possible propaganda working against them.. At this stage, your views should be somewhat balanced with enough reason to trust and not to trust.. The final episode will then decide whether you tip to the trusting pack or otherwise..
Till we meet again soon.. Salam..
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