Untitled - South East Asian Journal of Medical Education

Outside the boxEthicsArjuna AluwihareThe re-establishment of the South EastAsian Regional Association for MedicalEducation is welcome- more so is thisjournal. Upgrading the emphasis, scope,and relevance of ethics is a necessary partof improving medical education in theregion. The comments that follow, whichare not meant to repeat what is usuallydealt with, are designed to provoke somediscussion perhaps, about this subject in adifferent way.We usually consider the doctor-patientrelationship when we speak about ethics.Part of this has to be the evenhandednesswith which we deal withprivate and public sector patients. Inparticular if we work (legally preferably) inboth sectors we need to make sure that nopatient can gain any advantage in thepublic sector by virtue of a fee paid in thepublic sector. Our communication in thepublic sector must be good enough toensue that no relatives creep for a fee intothe private sector merely to find out abouta patient or get something done.Obviously we must not solicit directly orindirectly, or accept any fees for any kindof service given in the public sector (forwhich we may be paid by government oruniversity). It is best to keep the twosectors in separate compartments.As regards non medical staff, nursing,technical, and all other grades, the need toconsider and respect them as teammembers with different and necessaryabilities is often articulated. Thearticulation and practice tend to differ insocieties which are still very stratifiedfinancially and according to social class;this is unfortunate. Respect producesefficiency and loyalty to the team and thetask- and therefore the patient.Medical colleagues are often left out of thediscussion. We need to avoid denigratingcolleagues in competition with us. Thisapplies to both seniors and juniors. Weneed to be able to be seen to be willing toadmit mistakes, and to learn from ourstudents. We need also to be able toshare scarce resources without hoardingwards, theatres, equipment, and staff asthough they are some god given personalproperty. We need to be able to referpatients to, and discuss problems witheven those with whom we have somedisagreement of a private nature, if suchdiscussion and referral is in patients’ orcommunities’ best interests. If these tenetsare not observed patients may be sent outof a town merely because one doctor doesnot see ‘eye to eye’ with another for someprivate, or union, or ‘medical politics’reason. Such cannot be in a patient’sinterests.Governments have a duty to look after thepublic and we are instruments of such‘looking after’. If we wish to keepgovernments off our backs and avoidpoliticisation of our activity, we need to beable to monitor ourselves and ensue thatwe have kept the patients and communityinterest uppermost rather than someparochial need (such as a cost ineffectivebut wonderful piece of new equipment).This is also ethical behaviour.These are a few comments which I feelare relevant to the dimension of ethics- toprovoke debate and action please.52South East Asian Journal of Medical EducationInaugural issue