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Stressing ethics in medical practice

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The healthcare sector is at the crossroads in terms of ethical practices. Instead of using a credible internal mechanism to prevent business interests from overriding patient welfare, hospitals even in the U.S. are inviting trouble in the form of a law to protect patients’ interests, says

Marc F. Swiontkowski, Professor at the Department of Orthopaedics in the University of Minnesota in the U.S.

The specialist in trauma care and limb salvaging surgery discusses with

K.V. Prasad a malaise that thrusts unwanted implants on patients or promises to restore through surgery what even magic cannot.

“The trend is towards legislation. But, there is still scope to check it,” he reflects on the situation in the U.S., which is a warning sign for other parts of the world. Dr. Swiontkowski targets the hard sell method that ignores the concerns of the patient. While surgeons are supposed to obtain the informed consent of patients before a surgery, unrealistic promises abound. The question is: how factually informed is the informed consent?

“Surgeons should not make unrealistic promises. They should not promise a cure when it is not possible,” he says. Dr. Swiontkowski calls for whistle blowers from within the profession. Right thinking surgeons in a hospital should stand up against unethical approach, specifically unrealistic promises to patients. “Good doctors should stand up against the bad ones. They should go to the public and the media to expose unethical practices.”

This becomes extremely important in the context of claims of cure for various problems -- for instance, stem cell treatment. Medical profession has to rid itself of non-clean practices and unsubstantiated claims. It is dangerous for patients when surgeons take up procedures beyond their capabilities.

Another serious issue in the U.S. is bribery in medicine. Implant manufacturers push their products aggressively and this has led to a situation where more implants are put into patients than necessary. The American Board of Orthopaedic Surgery is keeping a close watch on the situation. It can even withdraw certification from surgeons.

Dr. Swiontkowski, who has specialised in limb-salvaging surgery, says no unrealistic promise should be made to patients when they undergo such a procedure. They should be told of the difference between the functional capacity of a limb before an accident and after the surgery.

Patients must be told that running costs for a lifetime are avoided through salvage procedures. Prostheses involve running costs.

In many cases, a change of the prosthesis is required in the first year after amputation because of stump (of the amputated leg or hand) shrinking. Patients should also be told that salvage is sometimes not possible. In one-third of accidents, limbs are amputated. Dr. Swiontkowski strongly advocates an inclusive approach to medicine, wherein patients’ interest should get priority. Patient expectations are high. The younger generation now insists on participating in decisions on surgery.

The informed consent, therefore, comes into play. The success of a surgery depends on the severity of the injury. So, the actual position must be told to the patients and this is for their good. Therefore, the best approach for hospitals is: “Doing well by doing good,” he says.

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