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Commentary"Practice of Medicine" The practice of medicine today has become more complex because of professional and societal changes. There are more choices to make, more things to keep up-to-date and more outdated information to discard. Patients too are generally more knowledgeable, which is a good thing, but many of them are also becoming overly demanding.
What lies ahead? There are many things to grapple with. These things could however be narrowed into two categories: the professional side of medical practice and the business side of it.
Professional side of medical practice
We need to keep sight of the scientific basis in our practice. Evidence-based medicine is a newly-introduced buzzword but nevertheless, a useful concept. There is a need to examine the evidence for the way we practice. This is especially true where the methods of treatment are many. Take acute backache for instance. A Swedish group on technology assessment have come to the conclusion that the effective treatment consists of analgesics and a short period of bed rest, no longer than a week. Physiotherapy is not found to make a difference. The diffusion of new knowledge to practice takes a long time and there is a need to speed this up. It must be pointed out however, before the murmurs of sceptics become too loud, that the basis of the evidence needs to be scrutinised to ensure that the studies are not flawed.
New technology in particular must be backed by the assessment of its usefulness and its place in the armamentarium of modern medicine. There many new innovations that have proven to be useless. Also, the assessment should be conducted before they become part of the accepted regular treatment. With time hallowed use, ineffective technology can be difficult to dislodge.
A logical step from evidence-based medicine is clinical guidelines where a set of statements are made based on scientific evidence. This whole subject has been looked upon with sceptism from some quarters.
Perhaps, the role of clinical guidelines needs to be clarified. They are meant to be signposts and not cookbook recipes. The purpose is also not legal prescription. To be useful, clinical guidelines need a practical approach. They also need to be reviewed periodically to ensure validity.
Business side of medical practice The practice of medicine from time immemorial has been a perpetual struggle between the business and the professional sides of medical practice. And doctors can be lured by the promise of financial gain from business entrepreneurs, pharmaceutical manufacturers and industrialists. This can range from apparently innocuous persuasion to allow the sale of non-medically-related products in the clinic to more elaborate business arrangements like profit guarantees and discounts. Perhaps, the way out of this dilemma is to remember the meaning of medicine – to provide professional care in the patients’ best interests. The patient – friend or foe Certainly, the experience of many doctors of their patients have not been entirely positive. Fortunately, most patients are reasonable people, open to discussion and a fair dealing. The challenge remains in dealing with the minority who can give their doctors a hard time either by being litigious, hateful, dependent or unreasonable. Doctors, more than ever, need to foster a good doctor-patient relationship through good communication skills, care and concern. For the difficult patients, the solution lies in the doctors being professional, tolerant and assertive. The few patients who create unhappy relationships must not be allowed to negatively influence the attending doctor. It must be an exercise of positive counter-transference on the part of the doctor.
A/PROF GOH LEE GAN