Medicine
Whose benefit?
John Linklater
The Secretary ot State for Health and Social Security has recently issued a circular (HM(73)8) for the guidance of those employed in hospitals, with the intention of encouraging patients to co-operate in the medical teaching process, The need for this document and for the care and public money which was spent on its preparation is very dubious since the Sectrary of State himself concedes that very few, if any, patients ever object to being used as subjects of a teaching session, In this day and age, however, when all our traditions are open to attack and question, and all our standards are subject to erosion by the disruptive and destructive forces within our society, it was to be expected that the Government would have to bow to pressures brought upon it by the Patient's Association and other bodies. What is quite unexpected, however, is the soft soap tone of this government circular which seems to have missed the essential arguments implicit in the whole question of the place of patients in a medical education system. The correct reply to any patient who objects to taking part in medical teaching is to point out that if he is unwilling to contribute to the common fund of medical knowledge and skill, then he must himself be prepared to have his appendix removed by a surgeon who has never previously performed the operation under instruction and never stood and watched an appendix taken out as a medical student.
Our medical schools are among the finest in the world and it is part of the high tradition of medical education in this country that every doctor shall, before qualification, have seen and examined and discussed not only the common conditions but as many as possible of the rare and complicated ones, For this reason, the medical rarities and difficult diagnostic problems are referred to the great teaching hospitals so that in the end every general practioner may be able, if not to diagnose at sight. then at least to have a sound idea where the ultimate diagnosis will lie. Every therapeutic procedure carries with it a certain risk for the patient, however skilled the operator may be, and it is the aim of our medical schools to ensure that all students will have firsthand knowledge reinforced by practical experience whilst under instruction by physicians and surgeons, who are themselves specialists in a limited field, of every procedure which they will subsequently be required to carry out. This then clearly demonstrates the value of practical teaching in medicine. It is only the
utterly selfish person who would attempt to derive benefit from medical and surgical skills without contributing if called upon to do so. For the Government to write the circular without stressing this point unequivocally, in some way officially obscures one of the principal issues, and is an example of the unnecessarily placatory and conciliatory tone so often adopted by leaders of a nation when they have lost their own moral guidelines and no longer see the issues clearly defined. A man who decides that he will not contribute to the fund of medical skills and knowledge has no right to draw from that fund. This should be explained to him in simple terms. Whether he agrees to contribute or not, however, medical ethics and Hippocratic tradition guarantee that he will be treated with the best available care and skills, Paragraph seven. of the circular, which implies that a patient who refuses to cooperate in teaching might conceivably as a result be penalised medically by getting less that the best care, is outrageous.
There is, however, a distinct accidental and inevitable advantage which does accrue to the patient who is fortunate enough either to be used as a subject of a teaching session or to be referred to a teaching hospital. Such a patient will always be examined in very great detail, since there will be time for the various aspects of his case to be studied, not only by the doctor in charge, but also by a shrewd and perceptive audience watching intently, eager to find any loophole in their instructor's logic, or any detail which may have escaped the original assess ment, all prepared to offer sug gestions for alternative diagnoses and treatment. In addition, the doctor in charge of a teaching case will not only be well qualified generally, but will also have a degree of specialisation that enables him to instruct.
Most of the disasters which occur in medical treatment today are the result of pressure of work and lack of time, and one of the ways in which a patient can ensure against this under the Na tional Health Service is to volun teer as a demonstration subject. His problem will then be dealt with at greater length and in greater detail than would other wise be possible. There is nothing quite so stimulating to a doctor or a surgeon, nor anything so con ducive to meticulous work, as the knowledge that every part of what he does is subject to the searching scrutiny of a jury of • medical students.
It would have been appropriate for the Director of Health and So cial Security to introduce his pamphlet by listing the practical advantages that may accrue to a patient who is the subject of a teaching session, and to point out that, unfortunately, not all patients can expect these benefits. To describe the co-operation of the patient in teaching as being of value to the doctor is crazy, Alice in-Wonderland, thinking, if our doctors are meticulously trained and rich in experience then it is not the doctor but the patients who will benefit.
When my own time comes to seek the help of my colleagues in a professional respect, may I be the subject of a teaching session.
Previous page
