Caring for patients and their disorders

Abstract

As I write this news has just come through that a colleague of ours has been arrested by the Scorpions Unit for allegedly defrauding Medical Aid Schemes of about R35million. By the time you read this, further information will surely be available. My gut response is one of extreme dismay and disappointment. I would like to believe that this is an isolated incident. However, I find myself recalling incidents of other reports (from the media and one-to-one conversations) of colleagues selling various household items to patients using their medical aid cards as a form of currency. I find myself wondering whether reports of colleagues employing fourth, fifth and final year medical students, as well as interns, to do locums and to assist in surgical procedures, could possibly be true. Apparently some of these junior members of our profession have become so deeply enmeshed in financial debt that they see no other way out. At least, this was the explanation I was given when I asked why I was hearing about interns (and students) failing to turn up to do their calls and not being contactable for the duration of the call. Just as alarming was the information that a blind eye is often turned to these practices because more senior members of staff (registrars and consultants) are also involved in these kinds of practices and are sometimes unavailable when they have a commitment to be available. My other response is probably one of 'denial'. I do not want to even consider the possibility of these events being true. I would rather label them as 'rumours' and ignore them. I don't want to get involved. I don't want to have to deal with the consequences of finding out that one or more of these reports is actually true. I am grateful that I have not been given any names, dates, specific incidents or other factual details. I don't want to have to wrestle with my own conscience and sense of right or wrong in terms of a colleague's behaviour. It seems appropriate therefore that in this edition of CPD in SA Family Practice, we consider various ethics issues. I am indebted to Dr Keymanthri Moodley for her input into the various scenarios outlined below. We have tried to use very concrete examples (the majority are based on real-life situations) to illustrate application(s) of ethical issues and some of the thinking behind them.