"I swear by Apollo the physician, that according to my ability and judgment, I will keep this oath. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous."
Those lines from the Hippocratic oath serve as a reminder that being a physician should be a high and noble calling, not merely a business or a way to inflate one's ego.
The issue of medical professionalism has been a topic for discussion over the past few months. Former President Lee Teng-hui's (
Lindy Yeh's recent feature piece ("The mystique of med school," Aug. 13, page 2) discussed the often less than noble motives of medical students in Taiwan. The article also mentions a novel entitled Hospital, which although ostensibly fiction, was viewed by many as being an accurate portrayal of life inside National Taiwan University Hospital. The picture was not pretty. For the Taiwanese medical trade to improve, a system of accountability must be put into place.
Note the use of the term "trade." As it stands now, Taiwan's doctors are not in any meaningful sense a "profession." They are an unregulated trade -- no different than butchers and barbers. I say medicine is unregulated because although there are lots of laws in place there is zero enforcement. Laws that are not enforced, as a practical matter don't exist. This gap between laws and enforcement is a plague that effects most attempts at medical reform.
When discussing the quality of Taiwan's medical care one often hears this, "oh, Taiwanese hospitals have the latest, most advanced equipment." That's great. It is also largely irrelevant. CAT scanners and other diagnostic tools do not make the diagnosis nor deliver the treatment. Diagnosis and prognosis is a function of the physician's dedication, knowledge and professional skills. If those are lacking then all the high tech equipment in the world is not a substitute.
A person enters a profession for basically either love or money. This is true of doctors, lawyers and engineers. As recent polls of medical students in Taiwan make clear, it's the money. Money as a motive sometimes hides behind its evil twin which is "face" or prestige.
As the Times report points out, "the prestige of having a doctor in the family is a long-standing tradition in Taiwanese society."
Given the prime motive is greed, the issue becomes how the society can hold doctors accountable for their actions or inaction. Professional accountability for doctors comes in two ways; loss of their professional licenses and/or malpractice judgements. Neither works in Taiwan. Successful medical malpractice suits are virtually unheard of; most attorneys won't touch them because such cases are "losers." Also virtually unheard of are doctors losing their licenses.
When you mix together greed as motive, plus no civil liability, plus little fear of losing the license, plus no particular reason to care if the patient lives or dies, then you have a perfect formula for poor care. And that is exactly the situation we have in Taiwan.
A Taiwanese friend of mine was telling me, "I get so angry at the doctors, especially the new interns. They look down their noses at you, like they are gods and the patients are nothing. I sometimes want to kick them where it would hurt."
Perhaps it is time to kick Taiwan's doctors "where it hurts."
Brian Kennedy is an attorney who writes and teaches on criminal justice and human rights issues.
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