Thursday, July 23, 2009

Doctor's ethics in Singapore - the Tan Tock Seng Hospital study

Salma Khalik reported on the Tan Tock Seng Hospital survey of doctor's ethics recently.

I think the TTSH study is to be commended because I think we need to keep examining this issue and to keep a close watch of our local attitudes towards medical ethics. Having said that, I think there are a number of methodical difficulties in the way the study was conducted. One primary problem is that the sampling of local and foreign trained doctors immediately creates a bias. Most of the doctors who were trained overseas could have had a very different starting point as compared to those who had been selected into the NUS Medical School. Thus the difference in ethical attitudes may have been primarily due to the survey sampling biases.

At a personal level, however, I have witnessed myself the degeneration of professional attitudes in successive generations of students and doctors coming through. I have posted indirectly on some of these changes :

So I am really not surprised by the findings.

But even as I am not enamored with the medical school curriculum locally, I think it is more than a bit unfair to lay the blame on the medical school training.

Students who make it to the medical school have largely been forced fed by a drivel of elitist attitudes towards life by the time they come to medical school. But I must be careful not to over-generalize. Many students and doctors I see still have exceptional qualities and will make exemplary doctors. But an increasing number just show themselves to be self serving, egotistical monsters in the making. For these, their basic attitude is that society 'owes' them. I can't help feeling that this malignant life view had been created by the journey through some of the elitist schools that we have. By the time they reach medical school, their basic attitudes have already been formed.

The data produced by the TTSH study may simply reflect the proportion of students from 'elitist' schools who go to NUS as compared to those who have to go overseas. I would highly recommend that the authors re-look their data and see what the secondary and JC education background of their respondents were.

Sadly incorporating ethics teaching in medical school may not be as successful as some would hope.


angry doc said...

I think what would be interesting would be a follow-up study a few years down the road to see if the HOs' (who will then be MOs) opinions change.

angry doc said...

In fact, it would be even better if we can do a three-point study: one on application/interview to med school, one during housemanship, and one on exit from NUHH (the 'public' sector).

That will likely give an indication on when views on medical ethics are 'shaped', and whether they change. I suspect they are shaped mainly during medical school and malleable.

gigamole said...

Well...they will invariably be shaped by continuing life experiences, whether this is in med school, or the working years. (At least we hope their attitudes are still malleable...)

The question is by how much?

Intuitively, I tend to be of the opinion that most of this has been already shaped by younger life experiences.

To be fair, I think this not a problem unique to the medical profession, it's just that the public expectations with regards to professionalism and ethics seem more visible for the profession, plus the fact that many of our students are high achievers, and who also appear to be gifted with massively swollen egos.