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Elementary Clinic Lecture for 3rd year medical students at the faculty of Medicine National University of Malaysia Friday 11th April 2003 by Prof Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH & DrPH (Harvard) Deputy Dean Kulliyah of Medicine, International Islamic University, Kuantan.
1.0 LEADERSHIP IN SOCIETY:
A physician is a leader. Everybody is a leader in one way or another. The physician has grave responsibilities for the health and welfare of individuals and their families. This is a trust that must be fulfilled. The medical school curriculum and experience should be a lesson in social responsibility and leadership. The medical school takes the blame for not producing ethical leaders who have the guts to change and improve society. The physician gets the reward for any initiative that leads to introduction of something good in the community be it medical or non-medical. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. The medical profession must be in the forefront of social change and reform. The physician must play the role of leader in the community. He can lead when in the community and not the hospital. Inside the four walls of the hospital the physician acts as a technician and not a leader. The traditional medical school curriculum does not equip the future physician with leadership skills in the form of courses or actual field experience.
2.0 PHYSICIAN AS A MORAL MODEL:
The physician is a respected opinion leader because of intimate contact with the patients therefore his or her moral values, attitudes, behavior, and thoughts must be a model for others. The ideal physician must have upright character, devotion to duty, honesty, and compassion for the poor and the weak. He should call others to be morally upright.
3.0 LEADERSHIP ON MEDICO-LEGAL AND ETHICAL ISSUES:
The physician is expected to give leadership to patients on ethical issues that arise out of modern biotechnology. Examples are: forced tube-feeding of the elderly, forced treatment, patient’s wish for death, birth control, artificial insemination, and organ transplantation. He must be prepared not as a mufti or pundit who gives legal rulings but as a professional who understands the medical, legal, and ethical issue involved and can explain them to the patients and their families so that they can form an informed decision. In order to play this role well, the future physician must have sufficient grounding in Law. Muslim physicians, contemporary and ancient, did not write a lot about professional ethics in medicine because they assume that a Muslim society is ethical and is a protection against ethical transgressions. However recent experiences in Europe and America have shown that there are so many unethical conduct and that special coercive measures are needed. Unfortunately medical curricula do not prepare the future physician to be a leader in ethics. They give information about ethics but cannot make him an ethical person. Ethics cannot be taught as an academic discipline. They have to be internalized so that they may inspire and guide. Teaching ethics in a plural society is not easy. The initial ethical values of a student are important. A course in ethics may add very little.
4.0 CHARACTER OF THE IDEAL PHYSICIAN
An ideal physician is a multi-dimensional character described as having iman, taqwah, amanat, and akhlaq. Three aspects of iman bear directly on medical practice: monotheism, tauhid; predetermination, qadar; and contemplation, tafakkur.
Tauhid: The integrating paradigm of tauhid enables the physician to practice integrated and balanced medical care as explained before. Belief in qadar guides the physician in his work to know and understand that Life and health, and illness & cure are in the hands of God. He will understand that he is a tool and not the reason for the cure; all cure if from Allah. The physician has limited knowledge and limited ability and should not be arrogant. After doing all what is humanly possible for his patients, the believing physician trusts in God’s help and support. A believing physician will know that he cannot change the time of death since that is under God’s direct control. He will concentrate on improving quality of remaining life for his patients. As the believing physician goes about his daily chores, he contemplates about all what he sees. Medical knowledge and actual clinical experiences increase iman because the physician realizes the power and majesty of Allah who created the complex human organism and who cures it from the most severe diseases.
Taqwa: A believing physician is conscious that Allah is watching and is ever-present. He knows that other humans observe his actions. He will do well in public and private. He will strive to know the permitted and do it. He will even more intensely strive to know what is prohibited and avoid it. He will avoid being involved in prohibited medical procedures that result in destruction of life such as abortion, euthanasia, and assisted suicide. He will keep away from fraud, false evidence, lying and misrepresentation. He will not dispense forbidden medication.
Amanat: A believing physician will take his medical work as a trust, amanat. The trust involves three dimensions: commitment and sincerity of intentions, quality work, and social responsibility of being a role model. Sincere intention increases commitment. Medical practice is worship for the pleasure of God. Medicine is also a form of charity. The motivation of the physician should therefore be service and not personal enrichment and material gain. A believing physician will try to excel in his clinical responsibilities by making sure that he tries to achieve perfection and excellence. Professional competence cannot be compromised in any way. It is a major sin to undertake any medical procedure beyond the level of competence of the physician. A believing physician knows that he is accountable before God, the profession, and society at large. He will discharge his duties honestly using the highest standards of good medical care. He will avoid harmful, doubtful, or unnecessary treatment. He will strive to have regular updating of his knowledge and skills. He will engage in research for new and better treatment modalities; every disease has a cure. A believing physician will know that he has societal responsibilities beyond the treatment of disease. He will work to eradicate or alleviate social root causes of disease. In his personal life he will strive to be a role model of good character and behavior for the rest of society. He will not shy away from social leadership and advocacy for the less privileged or the oppressed.
Akhlaq: The physician must have humility, show brotherhood, and have social respectability. He should show humility to Allah, to professional colleagues, to patients and their relatives. He should avoid show-off, in its manifest and hidden forms. Brotherhood is manifested in the humane treatment and respect for all patients regardless of their disease and social status. The believing physician gives reassurance, empathy, consolation, psychological support for patients and relatives. He has a positive and optimistic attitude in the stress of illness. He also fulfils the basic duties of brotherhood with his professional colleagues. Social respectability is acquired by good public behavior and avoiding any negative behavior that violates this respectability. This should not be a mere show or acting in public when in private behavior is despicable. It must be sincere and consistent with an overall good behavior.