Medical ethics is a code of behaviour accepted voluntarily by the medical profession. Unfortunately, unlike other countries where the respective national medical associations lay down various codes of conduct and enforce them on their members, in our country, medical councils, both national and state, are not very vigilant and therefore cannot play the role expected of them. In such a scenario, the responsibility to practice ethically rests on the individual doctor.

With this background, let us look at paediatric practice, especially private paediatric practice in cities. Since the patients themselves are minors, not capable of taking their own decisions, practicing paediatricians have even more responsibility to behave ethically. Parents of sick children are also in a state of anxiety. Since they are emotionally attached to their children, they are not really capable of proper reasoning and judgement. According to the Code of Ethics, the doctor is expected to be very clear in communicating to the parents, relevant information on their child’s ailment, and the prognosis for the condition.

This could require communicating in regional languages as and when needed. The information should be given in such a way that it is as complete as required without putting any undue fear in the minds of the parents. This would mean that a good amount of time is spent with the patient and the parents. Unfortuantely, this is not seen very often in busy city practices.

Another aspect of private practice is the fact that records handed over to the patient as prescriptions rarely contain proper notes. The majority of such medical records contain only the names of the prescribed drugs. Bodies such as the Indian Academy of Paediatrics should set standards for record keeping.

This brings us to the common problem of overuse and misuse of drugs. The majority of problems seen in paediatric practice are routine cases — cough and cold with fever and diarrhoeas. Most of the time, such conditions are viral in origin. But antibiotics are prescribed freely, in order to produce ‘fast results’.

Childhood immunisation with certain prescribed essential vaccines is a well accepted programme in our country. Today, however, some private paediatricians are aggressively promoting some costly vaccines which have been classified as “optional”.

The doctor is expected to advise the patient to seek a specialist’s consultation whenever necessary. Currently there is evidence of an increase in the incidence of behaviour problems in children, due in part to stress. It is believed that one out five children needs psychiatric help. However, the antipathy towards this speciality is quite alarming. It is no wonder that the closure of the child guidance clinic in a reputed hospital for children has met with little protest.

Physicians have certain duties to their profession. They should contribute time, energy and means to the promotion of medical associations with which they are affiliated. They should also expose unethical conduct. However, not many physicians fulfill such duties, using their busy schedules as an excuse.

Doctors are not supposed to take patients away from their colleagues. However, children referred to a paediatrician return to the family physician only when they attain adulthood.

The treatment of disabled children or terminally ill children are other situations in which paediatricians must act with a lot of ethics and wisdom.

These are some of the common ethical problems in paediatric practice. With honourable exceptions, many of us need to improve our ethical professional behaviour to make the paediatric physician an ideal one.