In the first half of June this year, doctors at a teaching hospital in Maharashtra became part of medical lore in India as they were involved with the first documented case of Harlequin Ichthyosis (keratosis diffusa fetalis) in India. Unfortunately, the baby succumbed after two days, but the story of this sad death, and medical lore was overshadowed by something that left a bitter taste in the mouth. The doctors who helped the process of the birth of the child, identifying it as the once-in-a-lifetime experience that it was, lost the restraint that we are never taught to exercise about our patients. They ended up posing for pictures with the baby, and, in one occasion, smiled, much to the chagrin of many an observer. Naturally, this being the rarity that it is, spread through facebook pages and whatsapp groups like wildfire – every bit the viral sensation we do not intend to be.
I will, obviously, not share the image in question, but will reflect on the fall out of what happened thereafter.
There was a fair bit of outrage on the social networks, every bit of which was justified. A subsequent investigation was conducted and the two physicians who were found to have breached the code of ethics were suspended.
I agree wholeheartedly with the fact that the two doctors needed to be reprimanded. But, just by training our guns on those two poor fellows, we are just making them scapegoats. If I may ask the honest question, how many of the medical students in India are actually aware of the extent of clinical information they can share online or via whatsapp and other messaging groups? The thing that bothers me is that our antiquated ethics curriculum is not even remotely aware of the way in which bioethics, particularly medical ethics, needs to evolve to keep up with the changing challenges that meet our medical students and doctors. With more and more physicians going online everyday, with a poor understanding of what to share, how to share and who to share with, we are setting ourselves up for more such misdemeanors.
I am of the opinion that the doctors who were suspended represent just the tip of the iceberg of the problem. This should be accompanied with system-wide changes that have to stop the blame game, and instead promote an environment where people learn from mistakes, not to repeat them ever. Instead of a punitive and punishment-based system, a supportive and empowering environment needs to be built up.
So what can we do to change the course of such events? I think the following steps need to be taken, on an urgent basis:
- Sensitivity Training: This should be made mandatory for all interns and residents, especially at the beginning of their rotations. There should be a monitoring system in place that evaluates whether such training is leading to a behavioral change or not. Students or residents who err should be warned and taught proper modes of channeling clinical information.
- Communication Skills: This goes without saying that the doctor-patient relationship suffers in the absence of a good communication channel being open between the two parties.
- Developing Institutional/Regional/National Social Media Policies: The MCI recommendations have enough clauses that can be translated into a model behavior code for physicians to follow in their online interactions. Unfortunately, no one has done that yet.
- Empowering Environment Encouraging Course Correction: The Indian system relies too heavily on the carrot and stick approach, mostly favoring the stick. With issues like social media based clinical information sharing, there needs to be more of a supportive supervision going on. There could be designated online chaperones, who, if they notice behavior unbecoming of an intern or a resident, could privately message them to remove content that violates guidelines.
The incident was not in good taste, but personally, I do not think it was solely the two suspended doctors’ faults. I am NOT defending their behavior, but I think it is safe to say that most medical students are not taught any better. Instead of laying blame at the feet of the hapless house officers, there needs to be a more comprehensive system that needs to be held accountable, and that plays an active role in preventing such events. Doctors in India are demonized enough in the media as it is, we can do without shooting ourselves in the foot like this.The incident should compel us to look deeper into the malaise and not just dismiss the offending doctors and affect a symptom relief instead.
If our medical schools can foster a sense of supportive supervision, then through numerous small course corrections, such massive mistakes can be avoided.