Ethics in medical education

This is in response to Ethical problems in medical education by Dr. F. E. Udwadia . I congratulate him on a well written article that summarises the ills besetting our medical education system.

In his last paragraph, he decries the sharp, progressive fall in values all over the world, more so in our country’. I submit that this has happened in our country, slowly and steadily over the years since Independence, due to a steadfast refusal of the educated middle-class to involve themselves in the public sphere, be it social or political.

Social values are not lifeless or abstract but are living entities that need to be nurtured and shaped with time. If abhorrent social behavior is tolerated, it gradually becomes the norm with a gradual, steady downward spiral. We have felt that it is enough to be virtuous while deliberately closing our eyes to the lack of virtue around us. Many more have been guilty of the sin of omission than the few who have actually committed unethical acts.

Even while I was an undergraduate student in a Bombay medical school in the sixties, there were flagrant violation of ethics in the form of favouritism during exams, deliberate flunking of candidates to settle scores among themselves by examiners, hazing of candidates due to rivalry among the medical schools, to name just a few. Training posts and jobs as honoraries or full-timers required ‘pull’. Cronyism and nepotism were rampant. The power of money was obvious. The corridors of medical schools were agog with news of one scandal or another but though the doctors whispered about the wrong doing of their colleagues behind their backs, they rarely expressed disapproval to their face.

The reasons given varied from “How can I offend her/him, (s)he is a good friend, our families know each other?”, to the straight forward “Well, one needs the help of these people in future, so I can’t alienate her/him.” to “I don’t want to get involved in this muck.” and “What can I, a lone person, do against a powerful system?”

That times have not changed this attitude was brought home to me recently when I overheard a conversation where a doctor was relating how he was offered a suitcase full of money to pass a candidate in a postgraduate exam and how he angrily refused the bribe. Unfortunately, his anger did not extend to taking a meaningful action against the person offering the bribe.

If we want to change the medical scene we,the bystanders, will have to express strong disapproval to the miscreants, unmindful of the result of our action on the miscreant or ourselves. If we can register a complaint with the responsible authorities, however spineless they may be, that would be even better. Even a verbal censure has the effect of modifying objectionable behavior. This has been shown by Dr. Erwin Staub whose study on the role of bystanders was inspired by his observation of the treatment of Jewish people in Eastern Europe during Nazi occupation. We can certainly change the medical system but before that we will have to change ourselves.