Wednesday, 26 March 2014

New code of medical ethics released – and why it is meaningless

by Michael Woodhead
The most surprising thing about China’s new code of medical ethics released this week is how unsurprising it is.
The 39-item code of practice developed for medical practitioners by the Chinese Medical Doctors Association is a long list of banalities and the bleeding obvious.
It includes basic standards on doctor-patient communication and interactions that you would think should not need spelling out.
“The doctor should respect the patient and revere life,” the code states.
“The doctor should listen attentively to the patient and pay attention to their concerns and questions ... the doctor should ensure good communication with the patient, and respect the patient’s rational requests and choices” it says.
According to the CMDA, the code should be regarded as the 'Doctor’s Bible' and deserves to be studied continually.
The CMDA says doctors should understand that doctors and patients look at things from different angles, and doctors should try put themselves in patient’s position when in the consultation.
"The doctor is thinking about the diagnosis and the course of treatment. The patient however, is worrying about the cause of their illness, how long it will last, what effect it will have on their life and how much the treatment will cost," says CMDA director Li Feng.
If the patient does not listen to the doctor’s advice or does not agree with the doctor’s diagnosis, the doctor should ask questions to clarify the patient’s doubts and worries, she says. Patients should be asked to ensure they understand what is happening and asked if thy have further questions, she suggests.
Li Feng says doctors have a duty to show compassion to the patient and provide them with appropriate care.
Medical ethics means having 'charitable feelings of compassion and solicitude in the heart'. Doctors should have 'great love and warmth for patients in their hearts', she says.
This is all very well, and who would disagree with notions that doctors should respect the patient, listen to their concerns, care for them as best they can and maintain good communication? The real question is how doctors can be expected to do this in an environment where they have to see 60 patients in a single shift and can only spend a maximum of three minutes with each one? And how can the code address situations where doctors have a financial conflict of interest, such as when doctors work for hospitals where their employment contracts link  salary to the number of patients seen?
The code may useful in setting out the basic expectations of a doctor in black and white. But many of the 'standards' it sets are not only related to medical ethics or morality, but also to the health environment in which a doctor works. Respect, communication and attention to the patient are not only determined by a doctor's personal ethics - they are also dictated by the system in which they work. Perhaps China also needs a code of practice for the health system as well as the health provider.

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