Angry Doctor

Wednesday, July 08, 2009

The Doctor and the Virus

This letter to the ST Forum today got angry doc thinking.

H1N1 flu: Doctors' moral obligation overrides the law

LAST Saturday's report by Mr Andy Ho ('Flu: Docs need not swallow bitter pill') makes me feel that doctors are nothing but cowards. They have no compassion, moral obligations and certainly no passion in their profession.

Mr Ho indicates that doctors are not obliged to treat patients during a flu pandemic because 'under common law, no one is legally obliged to rescue another from danger'.

Fortunately, this is not the case. People choose to be doctors because it is their calling. They are passionate in wanting to heal the sick. There is a Chinese saying that goes, 'to heal the sick, one has the heart of a parent', so they are definitely compassionate and high in moral obligations.

The law spells out a lot of things, but moral obligation overrides the law.

Take this example. In a major road accident, the first to stop and help the injured before an ambulance arrives would be other motorcyclists. Parking their vehicles along a highway or expressway is breaking the law, but it is still done. Why? Because it is a humane act, a moral obligation...not because the law says so.

Ronald Lee

How generous of Mr Lee to risk lives that are not his own.

Fellow-blogger Gigamole seems to agree with Mr Lee's view, and frankly angry doc too thinks that risking his life to fight a disease is part of his job description.

But angry doc doesn't do it because the thinks it's a humane act or a moral obligation. His motivation comes from a... a different ethos, reflected here in the novel "The Neverending Story":

Only a Greenskin would have dared to hunt these beasts, and moreover they used no other weapons than bows and arrows. The Greenskins were believers in chivalrous combat, and often it was not the hunted but the hunter who lost his life. The Greenskins loved and honored the purple buffaloes and held that only those willing to be killed by them had the right to kill them.

The Greenskin and the purple buffalo, the doctor and the virus, the Old Man and the Sea.

It's only fair, don't you think?



  • I've stared viruses straight in the eyes routinely...

    ...but frankly I didn't see anything because they are nanoscale and they didn't see anything neither because they don't have eyes.

    By Blogger The Key Question, At July 09, 2009 9:40 am  

  • During SARS in 2003, the team of doctors I was working with got hit with SARS. I was admitted to TTSH for suspected SARS while my colleague had confirmed SARS and developed complications from the diease.

    Initially e were concerned why we were not given N95 masks to wear.

    However the official line from the hospital administration was that we did not have enough masks to go around and we did not want to cause panic. eg if doctors started wearing masks, then nurses would want masks, then health attendants would want masks, then receptionists would want masks, porters would want masks, cleaners would want masks etc You get the idea.

    Anyway we still went about our duties as normal hoping that the hospital had their bases covered. I had thought that our safety must have been taken into consideration when making decisions on whether to give us N95 masks.

    I never thought of it so much about me dying as a possibility.

    I was wrong.

    After I was discharged from TTSH (I did not have SARS) I served my quarantine and later went back to work at the hospital.

    These were my thoughts:

    1) I had 2 children at the time.

    2) My wife was not working

    3) I was the sole bread winner

    4) I was still young and had not acumulated much savings yet

    5) I did not have enough insurance coverage

    The thought of dying young never really crossed my mind prior to SARS.

    When I chose my profession as a doctor I never thought that it would involve dying young as part of the job risks. If anything, being a doctor should have been a relatively safe job in terms of risk of dying on the job.

    If I had died, I would have left behind a widow with 2 young children and little savings. I was more concerned about what would happen to them?

    Nevertheless, I went out to buy more insurance and continued to work. I was prepared to die.

    By Anonymous Anonymous, At July 09, 2009 1:09 pm  

  • People often make a big deal about medicine being a calling and all that.

    There is no doubt that the origins of medicine lead it to be referred as such.

    In the days of old, doctors were either part of the religious clergy or nobles. Neither of which had really very much to worry in terms of paying the bills, retirement or being sued for negligience. It was truly an honor to treat a fellow human being who was sick and the patients reciprocated with appreciation.

    But society has changed.

    Doctoring is now a job. Doctors earn a living from working and seeing patients. While they are paid relatively well, not every doctor is as rich as a noble from the old days. Neither do we have a church to take care of our medical bills, retirement plans, malpractice insurance etc.

    Hence I do feel it is a rather convenient point for the detractors to make when calling medicine a "calling" and how doctors should be passionate, compassionate, selfless and all.

    But the truth remains that life in this world today is a struggle for everyone; doctor or not. Sometimes one has to also consider the needs of the family and loved ones over the needs of their work (which in this case is doctoring).

    Patients can sue doctors for being negligient. Patients often complain about doctors for many things. Extremely high expectations are placed on doctors.

    From a historial perspective, this is understandable. But I seriously doubt dying for medicine should be an acceptable expectation from the public.

    We are not soldiers. When soldiers choose their profession they are fully aware of the risks involved. They are also trained for survival and equipped to have the best chance of survival.

    In my experience, medical school does not train doctors to survive death. (Heck it doesn't even prepare you for the complaints and legal suits you might encounter). We are trained to treat patients.

    Furthermore, we are often under equipped during "peace time" when the dangerous deadly enemy might strike just about anytime. Do doctors wear N95 masks everyday? maybe we should. But it would cost too much. Again money seems to talk loudest.

    There will be some doctors who have enough to retire and feel that dying for their work is not an option. Why should we begrudge their personal decisions? I don't remember ever making any oaths to say I would die for my work.

    On the other hand, most healthcare workers have little choice but to continue to go to work despite the danger of possible death. It is their job.

    So instead of criticizing and condemning the few who have the luxury of being able to choose not to work and expose themselves to danger, I think the public should instead appreciate the health care workers who continue to serve in the face of death.

    I know what some would say. "But you are paid what!"

    Well then if it is as simple as just being about money, then please stop talking about medicine as a calling and all that.

    We have to serve you and have no appreciation at all simply because we are paid to do so. That's just so nice isn't it?

    By Anonymous Anonymous, At July 09, 2009 1:09 pm  

  • I think calling it 'a calling' is just a way to demand more of doctors without paying them more. Like 'work ethics'.

    But to be brutally honest the fact that you may be leaving your wife widowed and children orphaned without financial protection has nothing to do with your profession - you could just as easily die in a traffic accident and leave them in the same predicament.

    As for the fact that we are exposed to infections in the course of our work I think that is something none of us can claim to be ignorant about. The question is really about the adequacy of protection for healthcare workers, and whether or not exposing healthcare workers to risks actually benefit patients. In the early phases of epidemics these questions are always very hard to answer, but if an N95 mask and PPE isn't going to protect you from a disease with high infectivity and fatality rate, not being a healthcare worker probably isn't going to help you once it spreads to the community.

    By Blogger angry doc, At July 09, 2009 2:31 pm  

  • A little off topic.....

    Practising medicine these days is more about practising safely and avoiding problems, mistakes, complaints and legal suits.You can see 99 patients and treat them well and nobody gives any bonus or kudos. But make a mistake on the 100th patient and they will shoot you. Hence nothing to gain, everything to lose.Practising defensive medicine is the way to go.

    By Anonymous Anonymous, At July 09, 2009 5:50 pm  

  • To be fair we apply that standard to most people who make decisions that can result in lives being lost. When a pilot crashes a plane no one is going to care about the 99 times he landed one safely either.

    And think about all the times you've made a mistake but no life was lost and you got away scot-free.

    It's really a moral and philosophical question...

    By Blogger angry doc, At July 09, 2009 9:33 pm  

  • The difference is that in some professions it pays extremely well to have taken a risk and gotten a result from it. So well that it could set you up practically almost for life.

    With that, it doesn't matter so much if you make a mistake next.

    Your analogy of the airline pilot is too similar to that of doctors.

    Doctors and pilots? Of course we'll shoot them if they make mistakes. We pay them to be safe. But there is no such thing as being safer than safe is there?

    Forex traders and fund managers? Multi-million dollar bonuses? Surely not to be just safe.

    By Anonymous Anonymous, At July 09, 2009 10:07 pm  

  • Another point with regard to pilots....

    When a pilot makes a mistake, he can kill or hurt hundreds. In other words, when he is safe and correct, he is safe and correct for hundreds as well. There's leverage in that. Not to mention he controls a multi-million dollar piece of asset as well. Hence the justification for higher pay.

    Interestingly enough, few pilots ever get sued for negligence because they die along wit their victims. Do pilots buy negligence insurance?

    Whereas for doctors, in most cases, each mistake probably only kills or harms one person. It is easily traced back to the responsible doctor and causation and effect can be affirmed. Also the doctor's exposure to such potential risks are all the more higher because he sees many patients daily, each representing possible risk.

    Suppose a pilot flies 3 times a week. That means 156 chances to make a mistake a year. A surgeon operates on 20 patients a week. That means 1040 chances to make a mistake a year. Who has the better odds of making a mistake in his career lifetime?

    By Anonymous Anonymous, At July 09, 2009 10:17 pm  

  • Me thinks that jobs with priorities on being safe are important but very boring. Would not want my doctor to try out some new creative way to treat me. Nor do I want my pilot to make some rolls for fun.

    I suppose the challenge for these professionals is to attain ZERO accident/mistakes. Where's the creativity and excitement going to come from?

    Agree with anon July 09, 2009 5:50 PM point about doctors having to be safe.

    But I don't agree with him on practising defensive medicine. It would cost us too much.

    Doctors should be able to manage safely and control the cost of medicine.

    I certainly want 100% safety at the lowest cost possible. Otherwise what do we train doctors for?

    I find that doctors do too many tests these days. Can't they just be sure about something without having to do tests? It costs $8+ to consult a doctor at the polyclinic but $10+ for a test. Is the test worth more than the doctor? From where the money goes it seems to be the case.

    maybe we don't need doctors anymore.

    By Anonymous Concerned patient, At July 10, 2009 8:44 am  

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