Intellectual Judgment

Intellectual Judgment

 

Prof. Dr. Supakorn Rojananin, M.D.

Chairman, Department of Surgery

Faculty of Medicine Siriraj Hospital, Mahidol University

 

 

A recent report of the verdict of a doctor who was sentenced for 3year- jail without probation from wrong doing a procedure leading to the death of a patient causes a great shock among doctors in the country. In a same period of time, a non-drinker driver hit a pedestrian to death could be on probation and served in social activities for a short period of time.

 

To err is human is still true. As a doctor, a profession that is responsible to maintain a good standard of practice and care and to show respect for human life and wellbeing. Any mistakes may cause more or less effect to individual’s quality of life and tragedy not only to the patients but also to their families. However, as along as any doctors who are still practicing, some adverse effects might occur unintentionally or unavoidable in everyday activity, but all these untoward events should be recognized and handled accordingly and timely and communicated frankly or apologize when appropriate. Most suing in medical aspect in our country is not primarily due to the need for money but mostly due to the communication failure and un-satisfaction in patient care or system failure.

 

Most new doctors are vulnerable to wrong doing. Each year, there are about 1400 new graduates that are obligated to serve as an intern in the first year and serve the country in the rural area for two more years. They all are general practitioners who are less experienced in clinical judgment but shoulder the majority of burden of healthcare of the country in the forefronts. As President Ronald Reagan said in the Veteran Day in the past after Vietnam War that “ we will never again to sent our young men to fight and die, unless we’ve prepared to let them win”. This statement should reflect to our Medical Colleges and Ministry of Public Health that whether we have armed these young fellows enough and appropriately with the weapons of knowledge, skill and attitude. In addition to the hand skills that are mostly interesting among physicians but also communication skill, medical ethics and medico-legal and some administrative skill should be offered.

 

According to Professor, Dr. Viratt Panichabhongse, Committee of Thai Medical Council, since people demand better health care from their government and medical knowledge and management is also moving fast along with the high technology, any doctors who do not keep their knowledge and performance up to date with relevant literatures or continuing education through regular scientific meetings will put themselves obsolete and take more risk from malpractice.

 

Most hospitals in remote areas are under-staff, under-equipped, and overloaded, if not reorganized; brain drain will become worsening. Hospital accreditation should be implemented to all level and throughout the country. Good medical Practice should be set up as well as the competency appraisal and revalidation should be appropriately reconsidered.

 

To immediately ease these unsolved problems, those individual physicians should use the intellectual decision making based on evidence-based in their clinical practice. All physicians must

1 recognize the limits of your professional competence on knowledge, understanding, skill and experience before proceeding with any procedures in an elective basis.

2 make sure that your paramedics are fit physically and mentally for practice as an effective teamwork both in elective or non urgent and emergency situation

3 recognize the adequacy of your resources. If any deficiencies in resources that might impact on the safety of your patients, effective transferring is recommended to another colleague or hospital the required resources are available

4 recognize the support of your senior or director and your organization when needed.

5 recognize the local tradition, attitude and belief and level of participation or contribution to your hospital and act accordingly.

6 seek advice from your superior or medical council if you see your performance appropriate

7 above all, be honest and make the care of your patient your first concern; treat every patient politely and considerately, respect patients’ dignity and privacy and give their time.