Noble profession?

March 04, 2016


The writer is a professor of psychiatry.
The writer is a professor of psychiatry.

LYING in front of the TV on a Friday night, half asleep after a particularly busy week and an even busier clinic, I was suddenly jolted by an advert. A real-life physician — one I knew and recognised — was endorsing a brand of nappies.

I was shocked because a profession that William Osler, the father of modern humanistic medicine, referred to as a ‘calling’ had apparently been reduced to a commercial activity by a naïve physician and an unscrupulous advertising company. Was there any difference between the Pakistani physician and an Indian actress endorsing a shampoo?

More and more doctors in Pakistan are appearing in ads, endorsing products ranging from soaps, toothpastes, bleach creams and shampoos to cooking oils and detergents.

More and more doctors are appearing in ads.

Is there anything wrong with this? After all, models, cricketers, actors/actresses and TV anchors all endorse products. It helps sell the product and bring in profits for the company. If they are health-related products like soaps or detergents, so the argument goes, it also creates health awareness amongst the public.

In fact, there is plenty wrong with this and it goes to the heart of the difference between a profession and business, the core values of the medical profession and what it means to be a ‘physician’. Milton Friedman, the Nobel Prize-winning economist, is believed to have said that the “business of business is to do business”, meaning the primary objective of business is to make profits for the shareholders. Everything else is secondary. Using persons who represent a certain profession to endorse products is part of this marketing strategy.

The medical profession is different. Physi­cians have to undergo years of training, earn qua­lifications, have a licence to practise and update their knowledge regularly. Their practice must be monitored and those members who do not meet the set standards must be suspended.

The medical profession has a further requirement, ie adhering to ethical and moral values, as the profession deals with an extremely vulnerable group.

This differential in the relationship bet­ween the doctor, with all the knowledge and expertise and the suffering patient, requires ethics and integrity to bridge the gap. It is this reason that elevates medicine to “a moral enterprise grounded in a covenant of trust”.

Trust is a fundamental value in medicine. John Gregory, the 18th-century English physician referred to physicians as the “moral fiduciary of the patient”, ie a ‘trustee’ of the patient’s life and health. Hence the profession “became distinguished when specialised knowledge was used for the benefit of the patient” and “noble when the needs of the patient held sway over the interests of the practitioner”. Noble, moral and distinguished are revered words and make medicine a profession unlike others.

When a profession gets disconnected from its core values, its practitioners lose their identity and don’t know how to behave. Appearing in commercial ads is part of that disconnect. Doctors and dentists go to medical and dental schools to learn to treat suffering patients, not to sell commercial products.

The profession of medicine is under threat in today’s commercialised world as the values that made it ‘noble’ are being eroded, replaced by principles that drive businesses, ie profits. Medicine has moved from a values-and-ethics-based profession to a business, and terms such as ‘patients’, ‘compassion’, empa­thy’ and ‘noble’ have been replaced by ‘clients’, ‘customers’, ‘volume’, ‘targets’ and ‘revenues’.

In Pakistan, the problem is compounded by the fact that there is no accountability of physicians or regulation of medical practice. Ethics and professionalism are not taught in our medical schools, nor are there any role models. The PMDC, the body that oversees and regulates medical education and practice, is highly politicised and ineffective.

Professional bodies of different specialties are nothing more than social clubs, holding annual conferences with members flying off to attend conferences at the pharmaceutical companies’ expense. They are irrelevant to the healthcare system of Pakistan.

Almost 70 years after independence, we still don’t have a viable public-funded healthcare system. Private healthcare entities focusing on profits are flourishing instead.

It is in this context that doctors appear in commercial ads to endorse products in Pakistan. Unfortunately, physicians who do so have probably never been taught the ethics of medicine, nor do they have role models. What they imbibe from the larger Pakistani society, with all its venality and deception, normalises such acts.

When societies are mired in chaos, as Pakistani society appears to be, it is the responsibility of the educated — individuals, professionals and institutions — to provide guidance. Pakistani physicians, practitioners of the noblest of professions, must take on this responsibility.

Upholding the core values of the profession is the first step they must take in this regard.

The writer is a professor of psychiatry.

Published in Dawn, March 4th, 2016