Be gentle as a dove but wise as a serpent, the holy book admonishes.
In our every day life we are always torn between striking a balance between the two; when to let gentleness and it's other attributes including empathy and compassion take lead, and when to heed the often harsh but better counsel of the wisdom within. It becomes more important in a field such as medicine where ethics and the axe of the law on one side is in constant civil war with compassion,empathy, and the need to go the extra mile to save a life.
Ethics presupposes an ideal situation and the law was made on such a premise. But in the complex world of realities, ideal situations are a far cry from what is obtainable from real case scenarios and there is thus often the need to break or bend the law for the course of a greater good. In such scenarios however, the law becomes a fag, one that screws you over and over if you left your ass uncovered.
That you are ignorant of an existing law is no excuse, it is one's responsibility to get acquainted with the ethics of his profession and the laws guiding them.
In this vein, I have been reading this book on Ethics And Medicolegal Aspects Of Medical Practice like I'm gonna write primaries in it. And in it's lines, you would be surprised how grave your everyday activities, even ones born of the best and most human intentions, appears in the eye of the law.
Mr Bumble would say , the law is a ass, the law is blind and I pray it will one day have its eyes opened by experience.
[NB: "a" for "an" was deliberate, that's exactly how Mr Bumble said it in Charles Dickens classic, Oliver Twist].
Fact is till experience opens the eyes of the law, we have no option but to dance to it's blind tunes and covering our asses while doing so.
We have no option but to be a blend of Jekyll and Hyde, being the dove as well as the serpent.
SCENARIO
A man lay dying from anaemic heart failure and was in urgent need of transfusion with blood.
It was at the wake of one of the jehosu strikes, so the blood bank was not offering blood transfusion services and I was the only healthcare personnel in a remote outstation.
Without transfusion, the man's fate was sealed and referring out was not a feasible option as they had not cleared their hospital bill.
The only way was for the relatives to source for blood from outside the hospital. Apart from ethics, the safety of the blood cannot be vouched for with certainty. Even though it had been screened and cross-matched and found both free of HIV 1 and 2, Hepatitis B and C, and compatible with patient's blood, you just can't trust the results of a peripheral lab.
Between the devil and the deep blue sea, the deep blue sea is always a better option: there's always every chance that a coast guard may come to your aid,or that Sharks may do you the favour they did Jonah, that is if you don't get crushed between their powerful jaws first and still go meet the devil.
But if things goes awry, the ambulance chasing knights of the law will turn a blind eye to all these facts and still move to nail your ass. So like always, make a move to cover yours ass.
In the situation above I explained everything to the least including the fact that I can't vouch for the safety of a blood I don't know the integrity of the lab in which it was screened, not because I particularly suspected them to be inefficient or substandard but because I had never worked with them.
So when they said I should go ahead and transfuse [since he was dead anyway without the transfusion] , I have to make a draft for them to sign.
CONSENT FOR TRANSFUSION OF POTENTIALLY HIGH RISK BLOOD
This is to certify that I [name], wife to [Husband's name] hereby give consent for the blood with pint number which was sourced from outside the hospital to be transfused to my husband, [husband's name]
I have been dully counselled, and I am fully aware that neither the hospital [Hospital name] nor the doctor on call [my humble self's name] can vouch for the safety of the said pint[pint number again]
Therefore in the setting of blood transfusion reaction or any other related hazard/mishap, I [her name] accept full responsibilities and will not hold the hospital nor the doctor on call accountable/responsible.
CONCLUSION
In the above scenario, things went perfectly well. But what if it didn't? Would the law and it's ambulance chasing knights[lawyers] be reasonable enough to see that your actions were in good faith?
The law is a bitch, a blind and inexperienced one who can be manipulated to make selfless actions born of the best intentions look as if aimed to serve a selfish purpose in the light of cross examination. Once you take a stand in that witness box, all it takes is a learned gentleman clever enough to twist facts out of proportion, and everything changes, the dove of the holy spirit is painted to take the form of a vulture.
So this is what I do, I make sure my ass is covered; having made sure it is covered, I don't hide under that immunity and met out negligence with fragrant disregard; I still go the extra mile to give my clients the best I can with the limited resources I may have in a given circumstance. This is a clarion call to all doctors to do the same.
Be the doctor that goes the extra mile to save a life, but don't lose your hard earned license while doing so.
Fact is if you do, you would be robbing countless others out there, who would have benefitted from your clinical services in the future if you still had your license, of the opportunity to benefit from the same. Litigation is getting more and more popular by the second.
REFERENCES
Litigation is getting popular, but patients in Nigeria hardly sue the hospital and doctor for negligence, shady practices ( real or perceived) as is obtainable outside of here. But going out of the way to make sure a patient gets the best of healthcare is a gesture I will like to see more of. I saw a doctor do that recently; he was ready to operate even without anyone signing a consent form due to the urgency of the case.
You may have heard or read horror stories of the negligence often meted out to people in the public hospital. But the incident I just narrated above occurred in one. The issue is an individual one, keep up the excellent work. Bravo.
I still believe that Nigerian doctors need to do more. They are too complacent and believe to be immune to all forms of litigation. Medical Law is appealing more and more to me each day, some people need to be taught a lesson. Recently mdcn has been doing a campaign through social media for all Nigerian doctors in her registrar to review the red book and be acquainted with the code of medical ethics in Nigeria. for me the campaign is not enough more time should be dedicated to it, it should even be a course of it's own and not something taught for the sake of completion.
If proper knowledge of medical law is brought to the forefront, there is every tendency that a lot of lawsuits will be in the offing.
It will be a very welcome development. It will also reduce the amount of quackery going on in the medical profession and put medical practitioners on their toes.
Good post, have an upvote.
Although your post is good, I am not entirely sure that this post belongs in Steemstem though. Steemstem tends to stick to more science and technical side of things.
I wrote a style guide (link here) for STEM posts that you might find interesting (or not, up to you).
Thank you for stopping by and the link
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STOPa very interesting take on it, its hard when it comes to justifying your stand to others and convincing others that you are doing the right thing seeing that there are always two sides to a coin.