Daily Lessons from Life 28 July 2009

"Tue, Jul 28, 2009 The Straits Times - S'pore-trained docs more lenient on peers' ethics

SINGAPORE-TRAINED doctors are more lenient on colleagues who fall down on ethics compared to those who are trained in medical schools abroad.

They are less willing to have their colleagues disciplined or struck off the register even if they have a criminal record. Nor are they likely to tell on colleagues who are tardy or abrasive.

Two Tan Tock Seng Hospital (TTSH) doctors discovered this after posing real-life ethical questions in a survey of 112 final-year trainee doctors. One in four studied abroad.

Associate Professor Tham Kum Ying and Dr Loi Tsuan Hao said in their paper that the responses from doctors trained at the National University of Singapore's (NUS) medical school were 'suggestive of a tacit norm of non-criticism, a conspiracy of tolerance'. Even where errant behaviour was persistent despite intervention and counselling, they were more 'reluctant to escalate and implement disciplinary action' than doctors trained overseas.

The survey came in the wake of the conviction two years ago of a TTSH trainee doctor who had tried to film a female colleague in the shower. Among the questions asked was whether he should be allowed to practise as a doctor.

Fewer than half of the NUS-trained doctors said he should not be allowed to practise, compared to 71 per cent of their foreign-trained counterparts. Furthermore, seven of the doctors trained here found his actions pardonable.

Prof Tham and Dr Loi suggested a review of medical education here as the teaching of professionalism in the NUS medical school and its affiliated teaching hospitals seemed inadequate. Their findings supported claims by two in five NUS-trained doctors that they had not received good grounding in professionalism in their five years of studies and hospital attachments. A third did not find 'adequate role model clinicians exemplifying professionalism'.

In contrast, doctors trained in countries like Australia, Canada, Malaysia, New Zealand and Britain said they were well taught and fully understood what constitutes medical professionalism.

Until recently, there has not been much emphasis on training doctors on professionalism and communication while other medical schools may have started earlier and placed a greater emphasis on these areas."

A bold and interesting revelation by the medical professionals on themselves! This perhaps highlighted the inconsistency when we deal with non-technical and intangible issues like ETHICS vs. the hard skills medical knowledge and competence! It is harder to handle the soft side of professionalism!

Lessons for me are:

1. any profession that is called a "profession" is grounded on public trust! This foundation CANNOT be shaken, CANNOT be in doubt. The trust must be earned and earned consistently through exemplary behaviors and actions by the practitioners of the profession. The profession must held each other fully accountable to a set of mutually agreed and transparent standards of behaviors;

2. while it is tempting to shield or forgive or show leniency on your fellow professionals, especially when they are technically brilliant and might had even taught us or helped us before in our learning journey, when breach of ethical conducts happened, we must not confused sympahty with our public duties to uphold the integrity of the profession. Tough love is required here!!;

3. leader is a professional. A manager and a leader is to be held to the same high standard as the medical doctors or lawyers or accountants. This we must believed in. Only then will the people in leadership position realized that they have a lot of accounting to do whenever they or one of their colleagues fall short of the ethical behaviors demanded of leaders!

Everyone involved must accept and understand that whenever one of us violate the ethical conducts prescribed, we will have to face the consequences without any excuses or blaming those who reported us.

The integrity of a leader must be preserved so that mutual trust can be established and maintained.

May those medical doctors become better at exercising ethical judgement in the next study after they are taught how to interpret what is acceptable ethical behaviors. It is about the behaviors and not the technical brilliance! ;-)