Medical Ethics: Doctor-Patient Relationship and Physician Conduct

The Paternalistic Origins of Medicine

Dating back to the era of Hippocrates — also known as the father of medicine — a physician's advice was followed without question. Hippocrates, born in 460 B.C., fought against the superstitious beliefs of his time and observed that fresh air, a good diet, cleanliness, and, most importantly, plenty of rest helped patients recover quickly. Through history, we learn that the oath physicians undertake today before entering medical practice was formulated during that era, reflecting the sincerity and humility expected of those in the noble profession. Naturally, therefore, a physician of that era was viewed in a paternalistic manner, and the prevailing culture was one of passive and submissive acceptance (Oath and Law of Hippocrates, 1910).

Through time, there has been a considerable shift in the image society holds of doctors. Several factors account for this change. In many ways, the patient has had no choice but to remain silent and be grateful — for better or worse — for whatever care the all-powerful healthcare provider offered. This situation has led to blatant abuses of the doctor-patient relationship.

Erosion of Trust: Misconduct and Abuse

A telling example comes from an experience recounted by psychiatrist David F. Allen, who was called to an Emergency Room to provide a psychiatric consultation for a Hispanic woman who had come in with an anxiety attack and could not speak English. The on-call doctor, unable to communicate with her, assumed she had taken a drug overdose, passed a nasogastric tube down her throat, and washed her stomach clean. Later, in desperation, she told the psychiatrist that she had quarreled with her daughter-in-law, felt extremely distressed, and had wanted someone to talk to — but now felt even worse. This is a clear example of negligence on the part of a physician (F. Allen, 1976).

The most significant unethical episode in modern medical history was the Tuskegee syphilis study, conducted on African American men who had been diagnosed with syphilis. Known and effective treatment was deliberately withheld from these patients in order to observe the natural progression of the disease. This study did not come to light until much later, by which time many participants had already died from the disease while others suffered serious complications (M. Sade, 2003). More recently, in 2007, several doctors in Pakistan were arrested on suspicion of selling kidneys. The kidney trade is not uncommon in many developing countries (Butt, 2004). Pharmaceutical and health insurance company bribery has further damaged the image of the medical profession.

These incidents, carried out under the supervision of scientists and physicians, have greatly threatened public confidence. They represent medical misconduct and reveal a disregard for human rights committed in the name of science. The individuals responsible were not rogue or unstable actors; they were respected physicians and men of science.

Television programmes such as Grey's Anatomy and Scrubs have added a new dimension to the public perception of the medical profession, which is increasingly seen as one defined by glamour and drama rather than humility and noble service.

Cultural and Technological Influences on the Medical Image

Moreover, the vast amount of health information available online tempts many people to believe they can self-prescribe treatment — and perhaps even learn surgical procedures through platforms such as YouTube — thereby becoming overnight experts. This attitude, combined with the rising costs of medical consultations, minor surgical procedures, and treatment, has led to the worsening of many medical conditions.

The lack of governmental intervention and adequate funding has led many physicians to focus more on documentation and administrative tasks rather than time spent with patients.