Sunday, August 31, 2008

Madicine Is A Vocation.

Medicine is the science and practice of preventing,diagnosing and treating disease.It had its origins in ancient Greece in the 7th century BC and is one of the oldest and most respected professions in the world.

Perhaps the best known name in the history of medicine is that Hippocrates, the Greek physician who gave his name to the Hippocratic Oath and founded the Hippocratic school of medicine,which greatly influenced medical science until 18th century.

Incredibly, his followers believed that health was governed by the balance of four fluids or humours: phlegm, blood,black bile and yellow bile. Of course, medicine has come a long way since the "balance of four body fluids" with the recent advances in molecular biology and genetics which promise the revolutionize therapeutics in the future.

But today,we are going to look at the profession of medicine in terms of its philosophy and social responsibility, because medicine seems to have lost its way in a rapidly changing world. Both the profession and society are forgetful that medicine has an imponderable spiritual core that could be called its soul.

Medicine is a profession,unlike any other.It is not a nine-to-five job, nor a trade or a business that brings in a respectable income to provide a comfortable lifestyle. It is an exquisite blend of science and art. Medicine is essentially a vocation or a calling, which demands a lifetime of dedicated care for sick and infirm. A vocation is an occupation that is distinguished by altruism, a sense of social responsibility, and fulfillment of an ethical or spiritual need. The word "vocation" is derived from the Latin "vocare" which means "to call."

For the past five or six decades,we have witnessed a decline in the age-old values and ethical traditions of our healing profession. Perhaps,being neglect of the philosophy of medicine and medical ethics in medical education, before and after graduation, has weakened professionalism and the ethical foundations of medicine.

The core values of medicine are being submerged and lost in the materialistic paradigms of the modern world of private enterprise and business, marketing and advertising, wealth accumulation and consumerism. These paradigms are being embedded in a changing global culture, which has been largely subsumed by the concepts and methods of market economics.

While medicine cannot change all aspects of global culture, nevertheless, the medical profession can and must exert its considerable influence in society and ensure that negative economic and cultural forces do not undermine or dismantle medical professionalism.

Professionalism is governed by an agree set of rules and standards of practice and conduct, determined by the profession and society in the public interest. It is important that the medical profession does not interpret professionalism as a license to serve the interests of the profession itself, rather than the population it has a duty to serve.

It also has a duty to maintain professional standard, independent of political influence but accountable to the public it serves. A part from knowledge, it is professionalism, ethical practice and compassion that transform a doctor into a healer.

Despite modern health systems and profound advances in medical science and technology, patient-care studies show a steady decline in public satisfaction and trust in the doctor-patient relationship. Although a significant number of patients are satisfied with their individual doctors, there is discontent with total health care experience and a growing movement towards alternative and complementary medicine.

A Mori poll in 1999 asked the random selection of the public to say which professionals could be trusted to tell the truth. The result were: doctors 91%, judges 77%, scientists 63%,businessmen 28%,politicians 23% and journalists 15%.

In Malaysia, part of this disenchantment with modern medicine is related to the low morale of health professionals, particularly in the public sector. Overworked and underpaid doctors and nurses in public hospitals are experiencing exhaustion and disillusionment with a system that does not show sufficient respect and compassion for its workforce, a system that does not show enough commitment to providing health care for all, a system in dire need of radical reform.

Private health care is being set up in the marketplace and exploited for profit by businesses, insurance companies and managed care organizations. An emerging commercial culture is dehumanizing doctor and patient a like, causing glaring inequalities in health care and testing the moral leadership of the medical profession.

If medicine is allowed to become a business, doctors will become businessmen. Doctor are being reduced to replaceable "providers" and patients to generic "consumers". In managed care organization, doctors resemble factory workers, processing patients as items on a conveyor belt.

The Malaysian government is promoting health tourism and touting health care as a sale able commodity, calculated to increase government revenue and inflict a brain drain of specialists from government and university hospitals to the private sector.

The crisis in health care is partly an economic crisis of rising health care cost, but the profound crisis in medicine is a crisis of doctoring and the relegating of medicine as an occupation like any other.

Education in general has become an institutional and mass production process. It is widely recognized and recommended that the needed improvements in the quality of health care require fundamental reforms in medical education. The two most important responsibilities of any government are the provision of quality education and affordable, universal health care.

In Malaysia, private medical schools are multiplying without stringent regulation of curricula, teachers, and teaching standards, often as a result of political and business pressures. The medical profession in Malaysia has a duty to respond to such challenges and ask decision-makers if they realize that the health of next generation of Malaysians will be at risk from inadequately trained health professionals.

The three-thousand-year tradition, which forged a bond of trust between doctor and patient, is being traded for new kind of relationship. Healing is being replaced with treating; caring is being displaced by the technical management of disease; the art of talking and listening to the patient is being supplanted by the hum of sophisticated medical equipment. The human body is seen as a repository of unrelated, malfunctioning organs, often separated from the doctor's healing touch by cold, impersonal machines.

This is not to undervalue science and technology. On the contrary, healing is best achieved when art and science are conjoined, when the practice of medicine reveals a compassionate human face, when doctor and patient form a bond and caring partnership of equals.

In developing the means for modern health care, society has forgotten the "meaning" of medicine. Medicine is primarily a humanistic endeavour, not a purely scientific one. Science and technology have a rightful place, but medicine is a healing profession, and the contribution of a doctor adds up to more than the sum total of his or her knowledge and skills.

We often forget that the patient is a person who is far more important than the illness; that illness is far more important that the presence of disease; that, when a disease is not curable, the empathic care of the patient and grieving family provides hope and comfort. Our technological society is often blinded and carried away by belief in the technological fix and fails to see how we might treat each other as 'flesh-and-blood' fellow human beings.

Another flaw in modern medicine flows from the application of mercantile imperatives to health care. The profession and society need to isolate and combat the contagion of materialism and commercialization of health care, by re-injecting core human values into the corpus of medicine. The soul of medicine is in dire need of redemption.


The 1978 Alma Ata vision of health for All and the World Health Organisation's policy of Health for All in the 21st Century have laid down global priorities and targets which could create conditions for people worldwide to achieve and maintain the highest attainable level of health throughout their lives.

The medical profession has a moral and professional responsibility to champion and help to create the conditions that will provide the basic human right to life and health. As the social conscience of the international community, the medical profession must press governments to develop the political will to be focused and committed to turning the vision of health for all into a practical, universal and sustainable reality.

It is in this context that the medical profession has a social responsibility to be committed advocates for the alleviation and eradication of poverty and inequity. At the same time, the profession also has a public health responsibility to support those working to protect the environment from the impact of ecologically unsustainable economic development and other human activities, which are now exceeding the physical and ecological limits of the planet and causing environmental damage, pollution, global warming and climate change, all of which have serious health consequences.

In addressing poverty as the largest single social determinant of health, the profession has a fundamental duty to monitor economic globalization and work with advocacy groups to ensure that it will bring benefits for all. Already, there is evidence that trade liberalization and capital flows are increasing inequality, within and between countries, and undermining the provision of quality health care.

Economic inequalities have been widening steadily for almost two hundred years. The difference between the richest and poorest countries was about 3 to 1 in 1820, 35 to 1 in 1950 and 73 to 1 in 1992. The total assets of the 200 richest people in the world amount to more than the combined assets of 41 percent of the world's population of more than six billion people. Over half of the world's population struggles to survive on less than RM 7.00 per day.

Equitable public health systems, which offer affordable universal health care, are important expressions of social solidarity. But international policies and globalization of trade and services are removing protective barriers to enable foreign companies ti participate in the privatization of health services for profit, putting affordable health care beyond the reach of all but very affluent.

Although global health indicators are slowly improving, increasing inequality will reverse those gain. The rapid spread of HIV/AIDS has already lowered life expectancy in Africa and other countries and doubled the number of people infected with the disease in the last decade.

One quarter of the global burden of disease is preventable or easily curable. Seventy-two percent of the world's population has access to safe water, but 2.6 billion people still lack access to basic sanitation. The following annual expenditures in US dollars tell the story of the world's skewed priorities:

Basic education for all: $ 6 billion
Cosmetics in the USA: $ 8 billion
Water and sanitation for all: $ 9 billion
Ice Cream in Europe: $ 11 billion
Reproductive health for all women: $ 12 billion
Perfume in Europe and the USA: $ 12 billion
Basic health and nutrition: $ 13 billion
Pet foods in Europe and the USA: $ 17 billion
Business entertainment in Japan $ 35 billion
Cigarettes in Europe: $ 50 billion
Alcoholic drinks in Europe: $ 105 billion
World military spending: $ 900 billion


In his book, Medical Nemesis and Limits to Medicine, Ivan Illich, one of the most severe critics of modern industrialized medicine, censored iatrogenic diseases and coined the phrase, 'the medicalisation of health,' a derogatory term that is applied to over-investigation and unnecessary treatment of physiologically normal processes, such as normal pregnancy, normal childbirth, ageing and dying.

Although most doctor believe medicine to be a force for good and acknowledge that on occasion the practice of medicine can do harm, few would agree with Illich that the medical establishment has become a major threat to health. But many might agree with the concerns of the health economist, Alain Enthoven, who claims that unregulated medical procedures and treatments would at some point become counter-productive and result in more harm than good.

The question is whether we have already reached that point in the developed world, where health budgets are steadily increasing to provide expensive secondary and tertiary hospital care that only has marginal benefits. At the same time, many developing countries cannot afford simple, inexpensive public health measures, such as sanitation, clean water, adequate nutrition, immunization, vector control, and universal primary care, all of which would help to prevent thousands of premature deaths in children.

Illich argued that there are limits to medicine, that death, pain and illness are part of being human, and that all cultures have developed ways of helping people cope with these inescapable realities of life. He has castigated modern medicine for undermining these cultures and medicalise many of life's normal processes.

The Chamber Dictionary defines disease as "an unhealthy state of body and mind, a disorder, illness, or an ailment with distinctive symptoms caused by infection, for examples." Health is even harder to define than disease. The World Health Organisation (WHO) defines health as "a state of complete physical and mental well-being and not merely the absence of disease."

The British Medical Journal has defined 'non-disease' as a 'human process or problem that some have defined as a medical condition, but where people may have better outcomes, if the process or problem was not defined in that way.' In other words, you would be better off to leave non-disease alone and not have medical treatment for it.

In a recent survey, members of the British Medical Association voted the following top non-diseases in descending order of 'non-diseaseness': ageing, work, boredom, bags under the eyes, ignorance, baldness, freckles, big ears, grey or white hair, lack of photogenic looks, childbirth, allergy to the 21 st. century, jet lag, unhappiness, cellulite, a hangover, pregnancy, road rage and loneliness.

But there are some aspects of medicalisation that arise out of requests from families when they cannot cope with the ill-health of their loved ones. Some of these problems come within the scope of medicine, but there is a fine line beyond which medicine has only a minor role, if any.