When surgeons should opt out

QA surgeon related to me recently declined to conduct a procedure on my dad citing emotions. Aren’t medics prepared to deal with any patient irrespective of relation?

***

It is clear to me that you have a relative who is able to recognise the limitations placed on him by emotion. Just to make the point, can you imagine your relative the surgeon operating on his wife, mother or even daughter? If you, like most people can see why a surgeon might not want to operate on a close relative, then the case of the surgeon and your father must begin to make sense.

If he feels emotional about the procedure, then he must ask a colleague to do the job.

Your question reminds me of a clinical situation we came across some years ago.

A mental health expert developed malaria and had put himself on treatment. For the previous 24 hours, he had a fever, headache, was sweating profusely, was not eating and had not slept a wink. He had a splitting headache.

One afternoon at the clinic, a patient woke him up and complained that the doctor was being unprofessional by not listening to what the patient was suffering from. The expert had slept during a session! A few days later, the doctor was better and continued to look after his patients. He did however learn that like his patients, he is human, and therefore has both physical and emotional limitations at the workplace.

The patient did not however, seem to give the doctor space to be unwell! On the other hand, the doctor had presented himself as super human and therefore did not acknowledge the fact that malaria could make him ineffective as a doctor. Sleeping during a session had literally woken him up to the realisation that he was human!

The question you have asked leads us to another matter that is slowly coming up for discussions in medical circles. Globally, more and more regulatory bodies are monitoring the physical and mental health of doctors.

It is well known that many people who became doctors in Kenya prior to independence died at an early age. Many had problems with alcohol and some died before 50. It is speculated that a number might have suffered from depression or some other mental illness. In those days, there were no doctors able to look after fellow doctors. It was a case of “Physician heal thyself”.

Many colleagues who qualified at the time are now in their late 70s and early 80s. A number have worked with distinction all their lives but like their predecessors have suffered poor health in old age. Few prepared for their retirement.

It is for this reason that the Kenya Medical Association (KMA) and Kenya Psychiatric Association (KPA) have taken seriously the whole question of physician health. The Medical Practitioners and Dentists’ Board is at the forefront of this initiative. It is also the body that would have punished your relative had he operated on your father who is a close relative.

Upon graduation, and before one can practice medicine, doctors are required to take the Hippocratic Oath. The central components of the oath requires a physician to uphold medical ethics, to maintain confidentiality and to do no harm. It is possible that your relative felt so close to your father that he felt he might not be “the best qualified person to perform surgery on this patient” (your father).

Although nearly all jurisdictions have regulatory bodies for the medical profession, the ultimate custodian of ethical practice must be the physician himself.

This duty of ethical practice must include making sure that the doctor himself is in a fit and proper state of mental and physical fitness.

In this regard, doctors ought to be at the frontline of healthy practices which they recommend to their patients.

An obese cardiologist who does not exercise has no business telling his patients to modify their lifestyle to reduce the risk of a heart attack!

A surgeon who operates on a close relative who then develops complications has no defence when accused of trying to kill his brother so that he can get a bigger share of the inheritance.