Physicians treat patients and medicine is a moral enterprise. We all agree to that. Well, I hope we do. In teaching hospitals, doctors teach medical students to become future physicians. Yet, teaching is not all there is to it. From what I can tell, it is basically a “do as I do, not as I say” thing. So, not matter how hard the medical programme tries to teach students to be ethical, to do the right thing, unless the hidden curriculum speaks the same language, it is a losing battle.
Many student of medicine complain that some of their teachers go into the classroom, tell them how important it is to stand up, greet the patient, comfort the patient, treat the patient as a person not a disease and, once on the floors, they see a different scenario, often by the same tutor! They are told to respect autonomy and when in the clinic, they see live scenarios where the right to decide is dismissed. They are taught to be humble and when they shadow physicians, they sense humility has no place in the equation and that their curriculum is a sham.
What do we tell these physicians-to-be? Or better, what should we do, lest we regret?
Many student of medicine complain that some of their teachers go into the classroom, tell them how important it is to stand up, greet the patient, comfort the patient, treat the patient as a person not a disease and, once on the floors, they see a different scenario, often by the same tutor! They are told to respect autonomy and when in the clinic, they see live scenarios where the right to decide is dismissed. They are taught to be humble and when they shadow physicians, they sense humility has no place in the equation and that their curriculum is a sham.
What do we tell these physicians-to-be? Or better, what should we do, lest we regret?
يوافق الجميع على أن مهنة الطبيب تتمحور حول معالجة المرضى وعلى أن الطب مهنة أخلاقية.
في المستشفيات الجامعيّة، يتعلم تلامذة الطب كيف يعاملون المرضى كما يتعلمّون أسس أخلاقيات الطب التي هي أساس المهنة، ولكن واقع الأمر هو أن أفعال الأساتذة وتصرفاتهم هي التي تترك أثرا على التلاميذ وليس أقوالهم. لذلك، فإن ما هو معروف "بالمنهج الخفي" هو أهم بكثير من المنهج الرسمي المقرر. كم من تلميذ جلس في الصف وتسمّر يستمع إلى المحاضر يتكلم نظريا عن التواضع وعن احترام المريض واحترام حرية قراره بينما يجد هذا التلميذ نفسه أمام ذاك المحاضر الطبيب عينه في أروقة المستشفى وهو يتصرف بعكس ما كان يحاضر. هكذا وبلحظات معدودة يلغى المنهج الرسمي ولا يبقى في ذاكرة التلميذ – طبيب المستقبل – سوى ما رآه من تصرفات الطبيب المتمرس الذي كان له المثال الأعلى.
ماذا نقول لهؤلاء التلامذة أو ماذا نفعل حيالهم كي لا نندم؟
في المستشفيات الجامعيّة، يتعلم تلامذة الطب كيف يعاملون المرضى كما يتعلمّون أسس أخلاقيات الطب التي هي أساس المهنة، ولكن واقع الأمر هو أن أفعال الأساتذة وتصرفاتهم هي التي تترك أثرا على التلاميذ وليس أقوالهم. لذلك، فإن ما هو معروف "بالمنهج الخفي" هو أهم بكثير من المنهج الرسمي المقرر. كم من تلميذ جلس في الصف وتسمّر يستمع إلى المحاضر يتكلم نظريا عن التواضع وعن احترام المريض واحترام حرية قراره بينما يجد هذا التلميذ نفسه أمام ذاك المحاضر الطبيب عينه في أروقة المستشفى وهو يتصرف بعكس ما كان يحاضر. هكذا وبلحظات معدودة يلغى المنهج الرسمي ولا يبقى في ذاكرة التلميذ – طبيب المستقبل – سوى ما رآه من تصرفات الطبيب المتمرس الذي كان له المثال الأعلى.
ماذا نقول لهؤلاء التلامذة أو ماذا نفعل حيالهم كي لا نندم؟
Image above: Hugh Laurie "Everybody lies" - House MD
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I am a medical student and you couldn't have described this situation better!! Although we do not have classes in which we are taught ethics at our hospital-university, yet, our doctors tell us that we should behave in a certain manner with patients, and that we should treat them well and listen to what they say. We often talk with each other about the truth of the situation. When we walk with our docteurs in the floors, we see them acting differently! They do not respect the patient and the speak in their back! They do not stand up to say hello to them and they act like they are more important than patients.
ReplyDeleteWhere did the teaching go? I wish our university gived us morality courses. They give all over in the world. We should do that to and our doctors should act like they ask us to do. Not tell as do not smoke and smoke themselve! Some of us older students have changes and becomed bad like the doctors with time. I am afraid we will become like that if no change will be made..
Actually, in any field, education through modeling or observation of the practical aspects of the issue at hand is much more effective than frontal theoretical teaching of abstract concepts. Mentoring is essential in any training program and the hidden curriculum is much more powerful than the actual one. Having physicians who do not practice what they preach is not only a big problem when it comes to teaching ethical medical practices, it is detrimental to the medical profession in general and cannot be condoned. Unethical or inhumane physicians is an oxymoron (actually I would characterize such a physician as a moron himself/herself)! This cannot be acceptable whether in teaching or in general practice.
ReplyDeleteI would like to comment on the post by the medical student and as him or her: When you see something that is not what you have been taught, do you keep silent or do you actually say something to the doctor? I see this as a form of hypocrisy. This is not education. It defeats the purpose of education.
ReplyDeleteTo start with, all the responses agree about what Dr. Thalia proposed as a problem, when teaching do not match learning outcome due to absence of role model. The question is what to do about that? from student, practicing physician, and faculty prospective. What is the responsibility of the training program or university itself? Who is responsible for the evaluation of teaching and learning outcome? Is there a specific process to report such poor ethical practice? I agree with the previous comment on the rule of student. I encourage discussion in a polite professional way and the reflection on such experiences. It is our responsibility to provide at least honest feedback to physicians who disclose poor ethical practice . I believe that physicians who do not show respect to their patients should be excluded from the teaching process.
ReplyDeleteI am a med student too...
ReplyDeleteI have to say that while I do believe that the "do as I do' approach, or apprenticeship, is the best way for one to learn the practice of the medical profession, I don't believe that this holds true for the 'teaching' of medical ethics. There are too many prerequisites for this to be an effective method in such a wide and personal discipline as ethics. The major prerequisite, that in my opinion is lacking, is for the student to be receptive to these guidelines in the first place. If this prerequisite is not fulfilled, I'm afraid (and i see it everyday, any attempts of teaching ethics, whether in the class room, or in the wards, will be met with complete and utter cynicism and scorn from the student's side. This is a sad thing, and i cannot pretend to have any ideas on how to solve it.
I have a post about this matter on my blog. feel free to check out "ladies and gentlemen, your future doctors parts I and II...."
Cheers.
I think that what "Courtesy" and "Le Collegue" say is true. I also want to say that the docteur must be responsible for what he do in the hospital, not only be removed from teaching. Teaching take place everyday not only in class. When we follow our docteurs in the hopital, he teache us and we learn. If he is a bad exemple, we learn (sometimes, it depends on us also) bad things. So there should be a system that look at the behavior of docteurs always not only when they teach us. I study in a frensh university and we have some problems with that. I think it is the same in all universities.
ReplyDelete