“One of the fundamental reasons why so many doctors become cynical and disillusioned is precisely because the abstract idealism is worn thin, they are uncertain about the value of the actual lives of the patients they are treating. This is not because they are callous or personally inhuman: it is because they live in and accept a society which is incapable of knowing what a human life is worth” – John Berger.
In school, we’ve covered the fundamental principles of medical professionalism and ethics and last week, I touched on one of them – the principle of patient autonomy. Basically this means that physicians should be honest with their patients and empower them to make informed decisions about their treatment. People aren’t objects to be prodded and probed at the doctor’s will.
I had quite a discussion with some friends as to whether patients will ever be in a position to be “really informed”- not only in our Caribbean locales, but ANYWHERE – since the public’s knowledge of human anatomy and physiology is generally very rudimentary.
But, we agree that the attempt must still be made. It was noted that “informed consent” is more widespread in the US primarily because of doctors fearing medical malpractice suits!
Today I’d like to share a few thoughts on “the principle of social justice”. Now I know that some of you might be saying (with bitter memories of you or some close relative not being not able to secure vitally needed medical care).”Say what?? Doctors and social justice in the same sentence?!”
But there it is. We’re taught that the medical profession must promote justice in the health care system – including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.
The way I see this is that as doctors, we’ll be practising in health care systems at various levels of development. In Guyana, while my dad tells me that things have improved tremendously since he returned in 1990, it is still much below Trinidad.
But with whatever resource set we have at our disposal, we must be fair in our treatment to one and all. It does seem to me that our people are conditioned to defer to the “big ones” in society – and I suspect that doctors also do this – as the John Berger quote above cautions.
One troublesome area is that we’re cautioned about the physician’s professional responsibility for appropriate allocation of always limited resources – both of the institutions, especially governmental and of the patients’ finances.
Doctors, then, should practice a scrupulous avoidance of superfluous tests and procedures, shouldn’t we? After all, the provision of unnecessary services not only exposes one’s patients to avoidable harm and expense but also diminishes the resources available for others.
But from what I already have seen – both during my visits and readings about the U.S. Health system and even in my native Guyana in a couple of private hospitals – there is a lot of over prescription of tests.
In the States, doctors may be doing this because of an overabundance of caution from fear of being sued? But what’s the local excuse?? Making big bucks? While it may be a judgement call to assist in a better diagnosis, I do believe that a doctor should be aware of the social circumstances of the patient and be prudent.
Overall, returning to a previous discussion I had about our more “socialised medicine” than that of the U.S. I am firmly committed to our system. And based on what we’ve been taught, doctors also have a duty to work towards a medical system that is based on social justice.
While I happen to believe in free enterprise, I believe that medical care falls into “public goods” that must be guaranteed by the state. And I am happy that in Guyana we spend such a large portion of our Budget on health. The private medical care should supplement and augment the private system.
“He is not deemed to give consent who is under a mistake” – Anon
Every day, at some point, we usually have to make decisions – whether it’s a decision about what we’ll wear, or what we’ll eat or what TV show we should start binge-watching.
And despite those being seemingly not very ‘serious’ decisions, most of us still take time to weigh our options and make a decision based on all of the facts we have at our disposal. IMDB anyone?
Basically, what I’m getting at is that we all like to have all of the facts before we make a decision or commit to something – that’s just being rational. But there’s one area in our lives that many times, we’re kind of shoe-horned into making decisions without having all the facts, or understanding all of the facts.
And those are decisions that we make when we come into contact with the medical profession: when the question might literally be one of life and death.
One of the things that I’ve noticed when I’ve gone to hospitals (as a patient), doctors often don’t take the time to explain fully to their patients exactly what’s wrong with them and precisely why they’re suggesting a particular method of treatment. In the little that I’ve heard about conditions in the US, there’s much more sharing of information there.
And it’s extremely ironic that it’s the area of our life that’s the most “life-or-death” that we’re the least informed about when making decisions. Can we still call them “consent”? I wonder, if we’re just going along with what the doctor decides? For consent to be valid it must be “informed consent” and we have a big role to play in “informed consent” also.
Think about it, “informed consent” must be given voluntarily (with no coercion or deceit), by an individual who has capacity and by an individual who has been fully informed about the issue.
Interestingly what we’re being taught at school is that obtaining informed consent is a legal and ethical necessity before treating a patient. It derives from the principle of autonomy – one of the four pillars of medical ethics: Autonomy, Beneficence, Non-maleficence and Equality.
The ethical principle of autonomy requires that patients should accept or reject treatment based on a true understanding of their situation and on their personal philosophy.
But numerous studies have suggested that patients are giving consent based on misconceptions. There is a failure of communication: doctors are not doing a good job of providing accurate information and/or patients are failing to process that information. I suspect it is a combination of both.
While “informed consent” is great…how many of us can digest what the doctor might be talking about?
So it’s important to trust your doctor – they’ve take an oath to ‘do no harm’ (principle of Non-maleficence) to their patient so their decisions aren’t made to hurt patients, but rather to help them. But at the same time, many times there’s more than one way to go about helping the patient.
A surgeon might be more likely to recommend a surgical intervention – not because they want to cut you open and make money off of you, but because that’s their specialty and those interventions are what they know work. A medical doctor would probably suggest going a more medical route, treating the patient with drugs. Second opinions can help in this area.
As a patient, you have the right to ‘informed consent’ which means that if you need treatment, your healthcare provider must give you the information you need to make a decision. You shouldn’t have to blindly go along with treatment – you have a right to know exactly what it is you are agreeing to.
Consent means nothing if the patient doesn’t know what they’re giving permission for. It’s like those times kids try to get their parents to sign a blank piece of paper so that they can write an excuse to their teacher for missing school.
“Whatever women do they must do twice as well as men to be thought half as good. Luckily, this is not difficult” ― Charlotte Whitton
Today, March 8, is International Women’s Day, commemorated under the theme, “Make it happen”.
And though respect for women has come a long way from the days when women were confined to only domestic duties, it’s still proof that we still have a long way to go if there still needs to be a massive global event to remind the world of the achievements of the women in society. Not to mention the need to treat them equally.
Twenty years after its adoption by the UN at the end of the Fourth World Conference on Women on September 15, 1995, the Beijing Declaration and Platform for Action remains the most comprehensive international blueprint for advancing women’s human rights. The Platform for Action is an agenda for women’s empowerment.
As part of the 20th anniversary of the Beijing Platform for Action, UN Women undertook a global review and appraisal of implementation. Twenty years on from the commitments made in Beijing, no country has achieved gender equality.
Queen’s College, the premier Secondary School in Guyana, has a population of mostly girls. We out-performed the boys at Common Entrance, or NGSA, to earn places at QC. And then went on to excel there.
But even after all of that, when we’re done with school and ready to have jobs, we’ll be working in a ‘man’s world’ – a world where women are still not paid equally to that of their male counterparts.
A world where women have to work doubly hard: first do their job, and simultaneously work to prove to the doubters that they’re good enough to deserve to be where they are.
We’ve come a long way, yes. Women can vote now. Women attend college. There are female doctors, astrophysicists, astronauts. But we still have a ways to go.
The feminists of the 1960s and 1970s era made great strides towards shifting society’s attitude in the direction of women’s equality. But unfortunately, now, years later, when many of the big battles have already been won by the feminists of old, younger women take some of the rights that they have now for granted.
They truly believe that they owe nothing to feminism and they don’t have to continue the struggle.
And we’ve begun to backslide. On TV, in movies, on social networking sites, there’s just so much exposure, so many females dressing ‘provocatively’. I mean sure, you can wear whatever you like, that’s the point, equal rights and all of that.
But why do they choose those particular pieces of clothes? Mostly to appeal to males? So the “male gaze” still dictates what females wear, or in most cases, not wear. And what we strive to be.
Women might have the right to vote. They might be elected President. But how many are? Why? They might make brilliant discoveries, like Marie Curie, the only double winner in the Nobel Prizes. But what women really need, and what all the battles have essentially been all about, is respect. Women need to be respected. They deserve to be respected. But first, they need to start respecting themselves.
Dress however you like, you have that freedom, but always think about your reasons for dressing the way you do. Because in the long run, respect is worth a whole lot more than a couple of opportunities to wear skimpy clothes. We have to be seen as more than ‘meat’. This is not trivial because it defines much of our orientation in other aspects of life.
So until women are accepted for the great things that they do every day, until they are respected every day, until they participate equally in the economy we need to march in the streets for International Women’s Day.
Women deserve more than one day of the year to be appreciated, so let’s remind the world every other day of the year.
“Health care is one-sixth of our economy. If the Government can control that, they can control just about everything. We need to understand what is going on, because there are much more economic models that can be used to give us good health care than what we have now” – Benjamin Carson, US Neurosurgeon and Presidential candidate
One of the courses we have to take in medical School at UWI is “Professionalism, Ethics and Communication in Health” (PECH). It’s new and in fact it was introduced in 2013 when I started my studies.
Even though sometimes I’ve gotten a bit testy, sometimes thinking that some of the topics take away from “real medicine” I’ve grown to appreciate the course, since it does to provide a context for practicing medicine.
Last week, we were shown a documentary that featured the US health care industry and its connections with the insurance industry. I’m using the word “industry” advisedly since the US is the only country in the world in which medical care is so dependent on the “for profit” private insurance companies.
It is an INDUSTRY. This serves to distort medical care in the US – not only in pushing its already astronomic costs upwards (a concern for patients) – but also in heavily influencing doctor-patient relationships because the doctors also have their (stratospheric) medical malpractice woes.
This makes them double think – and double test – everything, pushing medical costs even higher.
I got into a bit of an argument with my colleagues because I thought since the premises of providing medical care in the Caribbean are completely different, we were off a bit of a wild goose chase.
Here, we follow the British system in which the state is supposed to provide free medical care to its citizens. Since it’s our tax dollars that eventually pay for the care, it’s not really free…but you know what I mean.
In both the British and our models there are of course, private medical hospitals at which patients have to pay for the care provided. And these are supported very heavily by people who may have private medical coverage.
In Guyana we have our National Insurance Scheme (NIS) to which employed persons made contributions along with their employers and which cover payments (or parts of them) to private hospitals.
For us in Guyana, it is useful us to understand what goes on in the US by imaging that if you didn’t have NIS or free medical care at hospitals, what would happen to you. You’d be dead, that’s what! And that’s no laughing matter. In the US, medical care for the rich is no problem… They have oodles of money.
The very poor also get free care through MedicAid. But it’s the middle and lower class workers that get the shaft and the brunt of paying for medical insurance. Almost half of them go without any coverage or very minimal ones that ensure they become bankrupt if they ever have a major illness. They have to pay Russian Roulette with their lives.
Another effect that private insurance has on US medical costs is that tests and medicine are over prescribed since patients with health insurance think, “the insurance will pay it”.
We’ve heard so much criticism about “Obamacare” in Guyana and of President Obama. All it is, is an attempt to make Health Care insurance coverage accessible to more Americans.
That is, he’s trying to make health care in the US closer to our system in the Caribbean. Affordable and caring- and for that he has been accused of being a “socialist”. That’s a curse word in the US, apparently! Very sadly it’s used by some of the very people that Obama is trying to help.
The “argument” I alluded to above had to do with one of my classmates from Trinidad claiming that “their system” was no different from the US. Apart from the usual Trini chest-thumping that we Guyanese are inherently backward, her answer really demonstrated that most folks here and abroad really have no clue as to what our governments do… including medical care and how they’re funded.
Thankfully, apart from adopting American traditions like Halloween and Thanksgiving, we in the Caribbean haven’t adopted the American dogma that “socialised medicine” is on par with dancing with the devil!
“I am no bird; and no net ensnares me: I am a free human being with an independent will” – Charlotte Brontë, Jane Eyre
Well, tomorrow is Republic Day and it really is an important day. I certainly wasn’t around way back in 1970, to know personally what it must’ve been like to live in a country still under the rule of another.
But I do know it feels better to be in control than to be controlled. And we won that right on Republic Day to make our own decisions without second guessing by a Crown. It’s like an ultimate version of becoming an adult.
My favourite hero in WI history was Toussaint L’Ouverture. To have a man – born a slave – take on the full might of one of the greatest European powers of the day, for the right to be free, was awe inspiring. He was indeed an “Opening”: the eventual independence of Haiti showed the path that every other colony had to walk.
So on Republic Day at least, we should make a point of being proud to be Guyanese. On that day we commemorate the earlier rebellion of our own Cuffy, in our own Berbice, for that same struggle to be free. I know some people try to raise some Guyanese pride on Republic Day, but unfortunately for most, it’s just about the Mashramani parade.
Granted, everyone has different ways of celebrating, of showing joy. Some people express themselves by parading down the streets in various states of undress in honour of Republic Day. Other people have more demure gatherings to celebrate the day.
But the problematic thing about it all is that most people don’t parade because of national pride. They parade to dress up (or undress) in costumes and ride on floats. Because it’s all about Mashramani – the celebration.
We’ve gotten so caught up with the celebration festivities, that we’ve completely forgotten why we’re celebrating in the first place. Who thinks of the meaning of Cuffy or Toussaint in the definition of what ‘freedom’ means?
One of the aspects of being free means that we’re a democracy – we can elect our own Government. I know I’m thrilled that I’m finally 18, so I can vote in the next election. Even though I just get one vote out of the thousands that are cast on Election’s Day, it still makes me feel like I have a say in who’ll be in charge of running our country.
And I’ll be thinking long and hard about which party has the best interests of the country at the top of their agenda before I cast my vote. Oil’s on the way…who’s going to introduce a petroleum engineering degree? A healthy nation’s a productive nation – which party will implement the best healthcare programme for the country?
Our kids are the future of our country and they need to have a sound education to ensure that they can have successful careers to continue the development of Guyana.
We still have so few scholarships that kids have to write over 20 subjects at CXC to try to grapple for either the regional prize or the two scholarships that Guyana gives out. Why aren’t we giving out scholarships to children for the different streams, example Science, Arts and Business?
That’ll encourage children to be the best in their chosen field, instead of having to spread themselves too thin to write subjects from all of the streams.
I’ll definitely be voting for whoever addresses the many issues that are currently plaguing our education system.
So don’t just wait until it’s close to elections time to think about whom you’re voting for- that’s when everyone will be standing on their soapbox making grand promises for a bright and shiny, new and improved Guyana.
Look at their actions during the year – what Bills are they pushing for in Parliament? Are they the type of people you’d want representing you?
We’re a Republic now, Guyana. We have the right to vote for who governs our country. So let’s think long and hard and make the decision that’ll be best for our country and our future.
Happy Republic Day!
“You can’t blame gravity for falling in love”– Albert Einstein
Yesterday, florists and confectioners probably tripled or even quadrupled their sales as people rushed to buy last minute „Valentine’s“ for their loved ones. Whether it’s a card or a simple rose or diamond earrings, practically everyone does something to show the special people of the opposite sex in their life that they care on February 14.
But why only on February the 14? It’s just a date chosen in honour of St Valentine who became associated with romantic love back in the 14th century. Weren’t people «falling into love» before then??
It could’ve been any other date or better yet, it doesn’t just have to be one date. Why can’t people show their love for the important in their lives every day? Or rather, why don’t they?
The persons you love should be important enough to you that you would have no problem with showing them that you love them every day – whether you want to show your love by just saying “I love you” or by showering them with gifts, it’s your prerogative.
Be spontaneous! Show your love every day in all of the little ways that count so much, much more than an elaborate show on Valentine’s Day.
And love itself comes in so many, many forms – you could love your mom, your dad, brother, friends, boyfriend, girlfriend and all of the other people on your life. Why should only romantic love be exalted?
But how many people consider all of those other people on Valentine’s Day? And if everyone did, there probably wouldn’t be enough flowers in the world to gift all of those people – so how are you going to show your love to all of them on Valentine’s Day?
You don’t have to – not if you showed them that you love them on the other 364 days of the calendar.
And that’s exactly what you should be doing. Let the people you care about always know and feel that you care about them. Sure, people aren’t perfect and someone is sure to step on your toes over time. But you don’t need to hold a grudge or put them in the doghouse – remember that you love them.
And I’m not saying you need to go around loving everyone because no matter how many pink sunglasses we wear, we can’t fool ourselves that the world is as rosy as we would like it to be. There are always people who we will find decidedly unlovable, and that’s OK.
You don’t need to love everyone and show everyone that you love them – that might be spreading yourself too thin (not to mention you also losing the plot of love being special and important).
You at least you ought to show the important people in your life, the ones you care deeply about that you love them because hey, if you love them that much, that shouldn’t be much of a problem – right?
But OK, even though you should be showing your love every day, it IS a nice gesture to go that extra mile on Valentine’s Day.
All hope isn’t lost, there’s still a lot of love left in the world. So where’s the love at? It’s everywhere – we just need to show it a bit more.