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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 MEDICAL EDUCATION: CONTENT and ISSUES
Medicine is closely associated with all the 5 purposes of the Law: religion, diin; life & health, nafs; progeny, nasl; intellect, aql; & wealth, maal. Study of medicine is therefore fardh kifayat. Medical students should learn basic and clinical sciences, the essentials of Islam, al ma’lum fi al diin bi dharurat, and legal rulings, ahkam fiqhiyyat, relating to medicine, and the social background to disease causation and prevention. In this lecture we shall discuss the following issues: purpose of medicine and medical education, integration, balance, and service.
2.0 THE ISSUES OF PURPOSE, INTEGRATION, and BALANCE
Purpose: The aim of medicine is to maintain or improve the quality of remaining life. Medicine does not have as an aim the prevention of death or prolongation of life because ajal is in the hands of Allah. The purpose of medical education is based on the paradigm of tauhid and the purposes of the Law, maqasid al sharia. The aim of medical education should be producing physicians who fulfill that purpose or maqsad within a holistic tauhidi context. These physicians will have the following characteristics: health and not disease oriented, focused on quality and not quantity of life because ajal is with Allah, humble to recognize limitations to their curative abilities, holistic in outlook (physical, spiritual, social, psychological aspects), understand society, scientific capability, clinical expertise, and leadership. These qualities must be in a context of iman, tauhid and fulfillment of the general purposes of the shari’at.
Integration: European medicine is characterized by narrow specialization and fragmentation. Fragmentation is a reflection of an underlying European secular world-view that separates religion from public life and science, and the body from the soul and the mind. Each disease or organ was isolated and was dealt with in isolation such that the concepts of ‘total health’, ‘total disease’, and a ‘total human’ were lost. Recent attempts at integration have not been successful due to lack of a guiding vision. Integration is not just putting two or more disciplines together. It is a fundamental philosophical attitude based on a vision and a guiding paradigm. There is a need for an integrative paradigm to replace the European non-tauhid world-view that is atomistic, analytic, and not synthetic.
Balance: Lack of equilibrium in medicine is a result of lack of integration. Modern European medicine lacks the concept of equilibrium or balance. It overdoes a good thing beyond the equilibrium point creating even bigger problems. Human illness is due to lack of balance and equilibrium and must be managed by a balanced therapeutic approach. The concepts of centrality, wasatiyyat; balance, mizaan; equilibrium, i’itidaal; and action-reaction, tadafu’u, provide a conceptual framework for balanced medical practice.
The tauhidi paradigm, integration and balance: The tauhidi paradigm implies integration and harmony of matter and soul, body and mind, parts and the whole. The physician should practice medicine as a total holistic approach to the human in the social, psychological, material, & spiritual dimensions and not an attack on particular diseases or organs. The tauhidi approach to integration is putting medical knowledge, teaching and practice in a larger context to making sure it is in harmony and is well coordinated with other related medical or non-medical phenomena. It is therefore possible to envision a very ‘integrated’ doctor who at the same time is very specialized. Such a doctor will approach the patient as a whole human and not just as organs or tissues.
3.0 THE ISSUE OF SERVICE
The paradigm of service requires that the physician should be trained to understand medicine as a social service. The human dimension should dominate over the biomedical one. The selection of medical students, their training, and evaluation should emphasize human service and not material gain for the physician. The medical school cannot be expected alone to effectively teach the spirit of serving others. The values and attitudes of self-less service for others are taught by the family and the community and are already well set by the time the student enters medical school. The school can only build on and enhance basic values that students bring with them from their homes and communities. In such circumstances, the medical school will do well to select those students who already have the vocation to serve. A medical education or health care delivery system developed within an Islamic society will have no alternative but to be service-oriented. This is because of the emphasis on mutual social support, takaful ijtimae. Society should look after the weak and less privileged: the widows, the poor, and the wayfarer. The social services must have the ability to seek out those in need even if they do not come to them seeking aid. Zakat is an obligatory payment to the poor and the needy. The obligatory fasting of Ramadhan is training and inspiration for the rich to remember the poor because they voluntarily taste hunger and fully understand the plight of the deprived. Many breaches of the law are expiated by kaffarat, normally feeding the poor.
Community-based education should include both materially-deprived and materially-well off communities because social and medical problems exist in both. Primary health care (PHC) is the first point of contact of a patient with the health care system. PHC can be simple in a rural area or quite sophisticated. It requires training a physicians who will be able to do the following: respond to health needs and expressed demands of the community; work with the community so as to stimulate healthy life style and self-care; educate the community as well as the co-workers; solve, and stimulate the resolve, of both individual and community health problems; orient their own as well as community efforts to health promotion and to the prevention of diseases, unnecessary sufferings, disability and death; work in, and with, health teams, and if necessary provide leadership to such teams; continue learning lifelong so as to keep their competence up-to-date and even improve it as much as possible. We can envisage medical education in the future taking place in primary care settings in both its simple and sophisticated modes.