The Muslim Doctor by Prof. Muhammad Idrees Anwar

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 Book Review

The Muslim Doctor by

Prof. Muhammad Idrees Anwar

An excellent informative book which can serve as a Guide for
ethical medical practice and good professional behavior by HCPs

RAWALPINDI: “The Muslim Doctor” authored by Prof. Muhammad Idrees Anwar is an excellent informative book which can serve as a guide for ethical medical practice and good professional behavior for the healthcare professionals. The author has tried to emphasize the importance of being a good human being and virtues of a kind hearted competent, intelligent healthcare professional who has mastered the art of not only good communication skills but also good listening skills. Based on his personal observations and experience, he has also supplemented all this with references from Quran, Hadees and Sunnah of Prophet Muhammad (PBUH).

The book which is a compilation of his personal observations, experience is divided into twenty chapters and the topics covered in detail include  ethics and professionalism, Disease and Treatment, Islamic Principles of Ethics, Core values and appearance of a doctor, concept of Khidmat, how to take informed consent from the patient before initiating treatment, manners in outpatient clinic, attitude of doctors in procedure room, making diagnosis, gender interaction and use of mobile phone in discharging their duties besides care of the terminally ill patients.

Writing in the Preface he has described appropriate conduct of a doctor and a medical student in the hospital and college premises, the prime responsibilities of a doctor towards ailing humanity. The doctors he opines must aspire to maintain the dignified image which a healthcare professional needs to project in both his personal and professional life. They should be careful not to let this image get tarnished. A true Muslim Doctor, Prof. Idrees says is considerate and solicitous towards his/her yearning fellow beings. Medical ethics is considered a set of moral principles which govern the practice of medicine. There is too much importance of morality which cannot be enforced through rules and regulations. Ethics is the way the doctors interact and behave with their patients based on cultural and moral values. At the same time professionalism looks at those behavior which they adopt in their profession. Whenever the ethical principles are compromised, it is called a conflict and an ethical dilemma. Traditionally the four well known principles of medical ethics as advocated in the West are Autonomy, Beneficence, Non-maleficence and Justice. One can add to them dignity and truthfulness and honesty.  While autonomy is given too much importance in the West, it has certain limitations in Islam which the author has not differentiated. For example, if a patient suffers from some infectious disease, since he or she can be a potential threat to the community, society at large, he or she cannot refuse treatment. Their autonomy ends where it affects the wellbeing of other human beings. Some of these differences in Principles of Medical Ethics as advocated by the West and those in Islam have been discussed in detail by Prof. Abdulaziz Sachidena a distinguished religious scholar and teacher of Medical Ethics from University of Virginia, United States.1 On the other hand Medical professionalism is defined as a set of values, behavior and relationship that under prints the trust the public has in healthcare professionals. Hence a professional is someone who can be trusted to do right things when no one is looking or monitoring him/her.

The assumption that doctors will learn ethics and professionalism automatically during their clinical training   may not be true. Allah, Prof. Idrees writes requires Muslim doctors to strive and search for cure and is daunted only after certain efforts have been put into its discovery. It is the duty of a doctor to do his best to find a cure for a disease and then leave the rest for the Almighty Allah. However, it should not be a halfhearted effort without any scientific basis or reason but a complete and perfect effort based on modern scientific principles and evidence based. Medicine is a noble profession and a vast majority of doctors are involved in ethical practice but their image is tarnished by misdeeds of a few who indulge in unethical practice. It must be remembered that once someone adopts career in medicine, it is a full time commitment to self, family, patient, students and by and large to the whole society. A doctor is supposed to be totally committed to medicine and should strive to obtain highest degree of professional excellence in subject he or she wishes to pursue and adopt as a career. He or she must be a lifelong learner and ensuring optimal care should be one of his most important objectives. He should not only look after the patients but also keep himself/herself abreast with latest developments in their specialty, conduct and publish research. He or she must know his limitations and if need be they should not hesitate to take second opinion in a difficult case to reach correct diagnosis. It is extremely important that healthcare professionals practice within their limitations and boundaries.

A doctor must have fear of Allah, know the rights of people, must adhere to Perfection and excellence, and have nice manners. He or she must endeavour to find a cure to every disease. A patient should be interviewed and examined in private and protect their dignity. Patients should not be examined and undressed at workplace unless necessary but in operating rooms, this principle, he says is often neglected and patients are exposed unnecessarily. Healthcare professionals must desist for ordering unnecessary investigations, procedures, use drugs for the benefit of their suppliers and manufacturers. They must ensure their continuous professional development. They should be tolerant and desist from rude and insulting attitude towards others.  They should not misbehave with patients and their attendants and other healthcare professionals including paramedics and nursing staff. They must not lose temper even in difficult circumstances. Ward rounds should not be meant to take care of patients but also used for teaching and training of juniors and other colleagues encouraging detailed discussions. They must remember that patient is not a client as is believed in the West but it is their religious responsibility to look after the treat then. At times they may have to face angry, agitated patients, ignorant attendants, colleagues, junior and seniors who might misbehave with them but they are expected to show extreme patience.

A doctor, Prof. Idrees states must be properly dressed.  If one visits ward of any public hospital these days, it is at times difficult to distinguish who is a doctor, who is an attendant or paramedics. They should be properly dressed. It is highly undesirable for the doctors to come to the hospital wearing tight and torn jeans with T-shirts, untidy dress. Similarly the female doctors should also desist from wearing close fitted revealing and showy clothes with heavy makeup.  Jeans, T-shirts and other trendy clothes are highly objectionable and must be avoided at workplaces. The author has given a clear description about the shoes which male and female doctors should wear and has  specially laid emphasis that dress by female doctors should not be very attractive  which should draw unnecessary attention, expose and reveal the figures. Low neck, short shirts and short sleeves are also highly objectionable. Hand washing in-between patients and after every surgery or procedure is a must. Lady Doctors should avoid long nails as they will interfere in examination of patient, performance of surgery. Doctors must also make sure that they do not suffer from diseases like excessive pride, impatience, injustice, worldly greed and are not infected with the materialistic virus. Practice of medicine is a team work and no one can work in isolation hence they must be a good team player while performing their duties. They must involve the patients and their family in the management of their diseases and they must be fully involved in shared decision making. They should provide privacy and examine their patients with dignity and respect. It is also important that they examine one patient at a time and in privacy but in our public hospitals one often sees the patients being examined in the presence of numerous other patients in the busy OPDs which is not at all ethical. The patients should be politely asked to undress themselves if need be for the sake of examination. Before undertaking any procedures like endoscopy, colonoscopy, surgery etc., the patients must be provided information to relieve their anxiety and fears. Intellectual honesty is another important issue. While examining a female patient, male doctor must ensure that a female nurse or some relative of the patient is present. Eye contact with the patient should be limited. While using mobile, it must be ensured that it does not create disturbance for others. While using patient’s personal information for research, the patient’s consent must be taken and the prime objective of research should be improvement in patient care.

End of life issues have also been discussed in detail in this book.  When death becomes inevitable as determined by the physicians who are taking care of these terminally ill patients, they should be allowed to die without unnecessary procedures with respect and dignity. One would have expected the author to discuss in detail the issues related to brain death and how and who should declare the patient brain dead. Similarly issues related to brain death and organ transplantation have also not been discussed. These are some of the important issues which the doctors and patients attendants have to face when the transplant surgeons are keen to harvest organs from patients who are declared brain dead. A little discussion, information on these issues in the light of various Religious Fatwa’s would have been extremely useful.

Medical students, doctors and all other healthcare professionals will find this book quite informative and useful in discharging their professional duties. Unfortunately there is no information about the publishers, printers of this 144-page book and no price is mentioned. Similarly there is no Index at the end which is considered essential for every book. When this book was published is also not mentioned. Perhaps the author did not take any advice from some professional otherwise; these things might have been pointed out and rectified.  The author is a senior medical teacher, Prof. of Surgery at Rawalpindi Medical College. As medical educationist, he is also on visiting faculty for Masters Programme of Medical Education at University of Health Sciences Lahore, University of Lahore and Riphah International University. On the whole the effort by the author is highly commendable particularly at a time when one sees unethical practices rampant in the medical profession.  SAJ

Reference: 1. Medical Ethics and the Muslim World: An interview with Prof. Abdulaziz Sachidena. Conscience Speaks by Shaukat Ali Jawaid. Published by Pakistan Medical Journalists Association 2005. Page 282-294.

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