Medical science

Whose responsibility?

There is no real reason why these matters should be the responsibility of the medical profession, but it is a responsibility that they seem to have shouldered because society in general has not yet accepted it. But there are many reasons why such ethical questions, except in the narrowest medical sense, should be a matter for society and not for the medical profession, let alone for an individual doctor. The accusation has been levelled that the medical profession has strayed too far from the original Hip-pocratic tradition of caring for the whole person in his environment. It has been suggested that the profession has allowed too wide a gap to grow between health care and medical care. By concentrating its resources on treatment, rather than on prevention of illness, cynics suggest a situation has been engineered whereby doctors’ incomes, their usefulness in the eyes of society and their status are increased. Doctors have been further accused of creating their own disorders -the iatrogenic disorders, such as the side-effects of the drugs they use. Finally, and perhaps most seriously, they have been accused of becoming a scientific, rather than a caring, profession. In this view, patients are not people, but statistics in the latest drug assessment, or operative successes in the funding battle for a hospital’s surgical department. There may be some truth in these accusations, but they miss the central point, which is that people probably get the medical services they deserve. The doctor does not act in isolation, but in response to what is demanded of him . He is faced with people who, having abandoned their responsibility for their own bodies, regard themselves as ill and demand a medical solution. It is the doctor’s role, and his training, to provide one.

He can, and does, go further, such as by giving advice on the prevention of disease, or on what constitutes a healthy or unhealthy lifestyle. But it is not the responsibility of the medical profession to implement such advice, or to legislate. Doctors have been pointing out the health risks of smoking for years, but in Britain and several other countries health education in this area has been a long time showing results. The medical profession has repeatedly stressed the importance of a diet low in animal fats, but the average diet has hardly changed at all over the last 30 years. And in spite of medical warnings about the dangers of excessive drinking, the proportion of dietary energy derived from alcohol has doubled in most Western countries in the last 20 years. Doctors can, and do, call for restrictions on the advertising of alcohol and tobacco. But medical considerations may not always prevail when any such decision is taken. People are like ostriches that bury their heads in the sand. Long-term effects of habits hazardous to health do not seem real. If drinking alcoholic beverages, smoking cigarettes and eating too much fat caused baldness overnight, surely their consumption would drop dramatically.

Alternative medicine and self-help groups

However impressive the technical progress of medical science, there have always been disorders that are beyond the reach of contemporary knowledge and techniques. It is likely to remain so always. Furthermore, wise doctors have long realized that technical expertise alone is not what many patients want. Most of the people who turn to ‘alternative’ or ‘complementary’ medicine do so because, for them, conventional medicine has failed to cure their symptoms, or has at any rate failed to make them ‘feel better’ (the two are not always synonymous).

Much of the popularity of alternative methods of healing lies in the fact that their practitioners still tend to treat the whole person, rather than the particular disorder or its symptoms in isolation. They are able to give the special attention that the busy traditional doctor may not always have time for, but which, whoever is giving it and for whatever reason, in some cases has an indisputably beneficial effect. The rise of so-called ‘self-help’ groups is a recent phenomenon that may be connected with the comments made above. Doctors, particularly hospital specialists, seem increasingly remote and rushed. The family doctor may not have the breadth of knowledge to discuss an uncommon diagnosis in detail. So certain patients, their families and friends may band together to pool experiences, advice and resources. Such interchanges are often on the practical, day-to-day level of living and coping with life. Pressure groups are also often formed to lobby for funds and increased medical research. In one sense this is taking medicine back to its roots: an individual accepting responsibility for his or her own health. But in another sense it may be seen as widening the gap between doctor and patient: patients are increasingly left to fend for themselves on a ‘mundane’ level, whereas doctors superspecialize, restricting their sights to one or two aspects of body function, such as blood haemoglobin level or urine analysis, and the patient as a person becomes forgotten.

In the final analysis, the medical profession is only one of many professions in a society, and it reflects that society. As mentioned above, people probably get the health service they deserve. The way to change unsatisfactory aspects of medicine, as currently perceived, is by social and political pressure over a wide spectrum of opinion. We must also recognize that throwing money at problems – especially medical ones – does not ensure that they will go away. In common with other scientists, most doctors see their brief as to use their skills to do the best they can with current resources, to present the facts, and let the people choose.

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