Humanize Medicine with curriculum change, ensure emphasis on social accountability & Human Dignity
Prof. Shabih Zaidi’s presentation at PMA’s 40th Academic Webinar
Humanize Medicine with curriculum change, ensure emphasis on social accountability & Human Dignity
Soft spoken, quiet and sedate, kind and generous, courageous but not
heroic, likes his solitude, non-interfering but helpful, life time learner,
matching knowledge and skills, moral and ethical are some
of the attributes of virtuous physician
LONDON: We need to humanize medicine with curriculum change putting more emphasis on social accountability and ensuring human dignity. The moral trauma inflicted by Covid19 pandemic had its impact on the medical profession. It resulted in loss of faith in health professionals, health administrators as well as research scientists. We need to produce virtuous physicians to provide healthcare. Some of the attributes of virtuous physicians are that they are soft spoken, quiet and sedate, kind and generous, courageous but not heroic, likes their solitude, non-interfering but helpful, life time learner, matching knowledge and skills, has special interest in moral values and practices ethical medicine. This was stated by Prof. Shabih H. Zaidi an eminent ENT, Head and Neck Surgeon with special interest in medical ethics. He was making a presentation on “The Virtuous Physician” at the 40th academic webinar organized by Pakistan Medical Association. It was moderated by Prof. Mulazim Hussain Bokhari, Principal of Azad Jammu and Kashmir Medical College, Azad Kashmir.
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Prof. Shabih H. Zaidi
Before settling in UK, Prof. Shabih H. Zaidi, it may be mentioned here had served as Principal and Prof. of ENT, Head and Neck Surgery at various medical colleges in Pakistan. He has special interest in Medical Ethics and was a co-author of a book on “Medical Ethics in the Contemporary Era” published in Pakistan in 1994. Other co-authors included late Dr. Maqbool H. Jafary, Dr. Unaiza Niaz and Mr. Shaukat Ali Jawaid. Since then he has been writing on this topic and making presentations at different forums.
Morality, Prof. Shabih Zaidi remarked guides rules about good and evil. Ethics is a branch of philosophy which also includes metaphysics, logic and aesthetics. It also covers theories and principles that govern attitude of a person to follow the right path. Speaking about Islamic principles of bioethics he mentioned Takreem, Birr, Adaal and Ehsaan. It is important that one must not harm himself or others. He also referred to Amar Bill Maroof and Nahi Anul Munkar besides covering the western theories of Kant, Birtham, Plato, Aristotle. Virtue ethics, Prof. Shabih Zaidi stated emphasizes on character building of individuals than rules. It emphasizes on things which are done repeatedly.
Continuing Prof. Shabih Zaidi pointed out that Courage is associated with fear and opposite of cowardice. He also emphasized on Generosity and modesty vs shamelessness, Friendliness vs loneliness. In health care distributive, retributive and restorative justice is important. Good intentions are not enough to virtuous but one needs progress, moral and practical wisdom. Virtues aim at achieving happiness leading to good life. He then discussed in detail How should one live, what is the good life and what are proper family and social values?
He then referred to the contributions of various famous western philosophers like Anscombe, Williams, Macintyre, Rosalind. Edmund Pellegrino another noted philosopher had stated that medical profession was losing its commitment to character traits. Patient has now become client and physician as health worker. A contract is drawn for service mentioning all good and evil outcomes. He reminded the webinar participants of a famous saying that “Half the illness disappears with a polite attitude of the physician (Tabeeb).
Tracing the historical background of medical education Prof. Shabih Zaidi said that Abraham Flexner based his curriculum on biosciences excluding humanities. He produced a curriculum based on sciences with knowledge of various diseases but in the process lacked humanity which was never taught in medical schools. Talking about Technology based medicine, he said, explosion of technology has removed the need of human touch. No finger on the pulse, no stethoscope on the chest and no use of third finger of surgeon. Technical care now far excels humane care. But patients do expect human touch. They need Human care of emotional, economical, psychological and existential parameter of an ailment which is called a holistic approach. Patient now feels that the physician is now neither caring nor concerned and was not performing the job. Moral trauma of covid was faced by everyone in healthcare professionals. There was loss of trust and authority. Health professionals lost a desire to live. Physicians, parents, teachers and public all suffered from moral trauma. At the same time Virtues during pandemic was amazing. People were courageous, shared resources, we saw volunteer ship, altruism, distributive justice. Sir Michael had remarked that Ethical physicians should look at social disparities leading to preventable health issues. Authorities, he opined, should be more honest, fair, transparent equitable and accountable.
We saw vaccines for Covid after a long wait but then what happened. It was the wealthy nations who hastily engulfed. They immunized major part of their population. Where was the conscience of the rich and famous leaders he asked? Many Nations in Asia and Africa were without vaccine or got very little of it. Who imposes wars and famines on the poor nations, he questioned.
Prof. Shabih Zaidi was of the view that time has come that we Design a curriculum which is engaging. Puts emphasis on preventive medicine and student’s engagement through andragogy. A physician has to be a lifelong learner. He suggested that we should ask them what they wish to learn and do not impose. Every teacher must a be a lifelong learner. During post covid curriculum remote learning should be incorporated. E learning is here to stay. Hybridization is the best way forward. Face to face teaching is the best but other options should also be explored, he remarked. Physicians must ensure that their Knowledge must remain updated. Skills match and Ethics is formally taught and practiced. We must produce Competency based physicians. Physicians must learn technology, own technology, become a technologist physician. He laid emphasis on social accountability, human dignity, individual and collective responsibility. Provision of service, he opined, must be based upon needs and not affordability. His advice to his physician colleagues was to keep away from other people’s affairs. Humanize medicine and produce virtuous physicians.
His presentation was followed by lively discussion. Responding to a question from Mr. Shaukat Ali Jawaid Chief Editor of Pulse Internaitonal regarding materialistic virus having infected the healthcare profession in Pakistan which has resulted in enormous increase in unethical practices, Prof. Shabih Zaidi remarked that this problem and greed is seen everywhere. World is full of greedy people. There is too much Commercialization because we do not teach philosophy, social sciences, humanity. We have no role models which have to be found. Social fabric has broken in the West and it is happening in Pakistan as well. Family values must be kept. Social society must be brought back. Replying to a question from Prof. Munir regarding commercialization and to suggest a minimum strategy, Prof. Shabih Zaidi mentioned that we must incorporate virtual attributes in physians. Guidelines regarding physician’s interaction with pharma industry are available. Pharma companies should not take doctors for a ride. They incite them and try to corrupt them through different ways. I remember Shaukat Jawaid has often written about it and keep on highlighting that the pharma companies then pass on all this burden to the patients in the shape of costly investigations and high cost of drugs and medicines. There is a need to Highlight these unethical practices but being a whistle blower cannot be easy, he added.
Prof. Shahzad Anwar referred to DNR (Do Not Resuscitate). We know that CPR can save the patient but then there are instances where the patient or the family has signed Do Not Resuscitate. What are the Ethical guidelines, how to go for DNR, is it ethically, religiously allowed? Is it the Patient consent which is important or the attendants? Prof. Shabih Zaidi responded by stating that in the light of different Fiqqahs of Islam, Life and Death belong to Allah. What is important is that let the humanity do not suffer. Let them die peacefully and with dignity. Do not prolong the misery of the patient. Be critical thoughtful. Patients should not suffer because lack or availability of resources. What the patient needs, patients must be helped. Do what is good and avoid what is harmful.
Dr. Musheer Hussain referred to the vaccine distribution during covid which he felt was not at all justified. He laid emphasis on the fact that Nobody is safe from covid unless everyone is safe. Unethical practices by the Pharma industry it is a problem here in Pakistan. We have to look at ourselves. When the students join medical college, they wish to help and serve the ailing humanity. But as they progress, their priorities change. For Career progress, money becomes important as they all wish quick promotion. Earlier we had Role models who wanted to help others. We have seen this change in attitude of the students from house job onward. We bear some responsibility and we have to look at ourselves too. We use DNR when it is needed and indicated.
Prof. Fazal Ellahie, Prof. Shabih Zaidi remarked was our role model. We had many other good role models in Pakistan but now the world is changing. It is commercializing. We must not be affected. Doctors can be well off but not wealthy and those who wish to earn more money, they should go to other profession. They must maintain dignity of the profession. Live within your means and for that set role models. Replying to yet another question Prof. Shabih Zaidi remarked that Terminal care is different from palliative care. Engaging the patient and the family members in patient management is important. However, if the patient is incapable, the spouse can be taken into confidence One of the participants remarked that it should be the patient not the family members who should take decisions in case of terminal illness. Prof. Shabih Zaidi remarked that when it is difficult for the family members to reach consensus, support from physians should be there and sought. Let them decide. Go to the Ethics Board and then decide on the situation keeping in view the case scenario.
At the end of the Webinar, Dr. Salma Kundi President of PMA thanked the guest speaker Prof. Shabih H. Zaidi, the moderator Prof. Mulazim H. Bokhari and the participants. We tend to ignore ethics in Pakistan but the guest speaker has rightly emphasized its important in his enlightening presentation, she added.