Errors vs Crimes

"I don't wish to be a doctor anymore. I used to do it to help relieve somebody else of their suffering. Now, all I do is to achieve some system's role or performance target, or fulfill some documentary requirement, or avoid some complaint, or guide the next generation in joining into this abyss. The suffering continues unabated. The sick and needy and injured keep coming. On my back, their care, and their satisfaction. On my back, the hospital - administration, ancillary, supporting services, and the others - insurers, payers, financiers, earn money. But on my back alone, I carry the burden when things go wrong"
Anonymous Doctor

Medical errors have received much attention. Doctors in administration and management have attempted to address it like doctors would - as a disease. Find out what happened, investigate to identify causes, and correct the problem with interventions. Like antibiotics for an infection. Initiate preventive measures to avoid the similar error happening again. Like vaccination. 

But the problem is that the two main parts of the equation, doctor and patient, are human. And humans aren't exact like science. That inexactness of humans will result in inaccuracies with communication - listening, speaking, understanding, interpreting; variability of actions - due to awareness, urgency, concurrent situations, prevailing environment; and acceptance of outcomes. It is this inexactness that gives intuition, gestalt, clinical acumen; and it is this inexactness that contributes often to errors. 

So medical errors will continue to be, as long as the parties involved continue to be human. System measures may place safeguards, usually to avoid simple mistakes; but often cannot address errors of interpretation. As medicine becomes ever more complex, and the body of knowledge expands to (almost) beyond capability, the number of errors are unlikely to be ever much less. 

But when did we ever promise that Medicine was free of errors ? Some may argue that it was at the very beginning with Hippocrates' "first do no harm". Surely I cannot argue with Hippocrates, but it is hard to think of any medical therapy which doesn't at least carry the risk of some adverse effect. Hippocrates' had he lived today maybe have said "first try to do more good than harm" reflecting the risk-benefit analysis which we do all the time. But then again, Hippocrates had he lived today, would probably have quit Medicine altogether. Especially if he had known about lawyers.

You see medical errors are the lawyers windfall. Negligence, they claim in their letters of demand; Negligence they claim from their side of the aisle. The error was the worst they had seen, and had directly contributed to the injury, or death. The doctor did it. Inexcusable. Strike him off the register. Unforgiveable .... but some money will alleviate the suffering of the family; and 40% for the "suffering" of the lawyers. 

It has gotten worse. In some countries, and some situations, medical errors have gone onto criminal proceedings. Crimes. Acts against the written law that may lead to jail. I cannot understand this. If I kill somebody, steal something, assault someone, cheat people, rape, maim, torture or even fake documents, I can understand jail-time because I did something. I committed a crime. BUT if I missed a diagnosis, when treating someone, I may end up in jail, professional career forever destroyed ? Is it a crime of commission, or of omission ? Are they the same ? Or is it, an eye for an eye type of justice ??

The crime of omission is a failure to act, often in medicine, a failure to recognize and therefore to act. This is considered in law, very different than crimes of commission, and therefore attracts different legal consequences. It give rise to liability only when the law imposes a duty to act. Yes, doctors often have that duty to act; but does the law impose a duty to be correct ? Furthermore, although the act of omission is considered actus reus ("the guilty act") criminal liability is considered only if proven in combination with mens rea ("the guilty mind"). So I really cannot understand criminal proceedings against doctors who are treating their patients. It is, to me, an eye-for-an-eye type of justice. Except that lawyers get paid for exacting the eye. 

Most professional organizations say that such actions are necessary to protect the integrity of the profession and its standards. Judge yourself from the article in the 1st paragraph if you think this is still the case. I think by allowing this to happen, the medical fraternity is tearing at itself, a suicidal down-spiral to its ultimate doom. A future of doctors behaving as pseudo-lawyers, patients as potential adversaries, eyes all the time on the money earned versus the legal risk incurred.

The medical fraternity is already the only one that looks at itself with the most critical eye. Mortality Morbidity meetings, inquiries, clinical conferences, quality monitoring, sentinel events, compulsory reporting, audits etc etc. This doesn't happen to any other professions. 

Imagine the gallery where a legal case in on-going involving medical negligence. Two spectators are there. One a doctor, the other a lawyer. The doctor is watching the doctors testimony and is thinking, that's wrong, i wouldn't have done this, or I may have done that in a similar situation. The lawyer is watching the defense lawyers tactics and line of questioning, and is thinking, that's not good, I wouldn't have used that tactic, he should have done this or that. And yet, only the doctor is on trial. 


You wanna do what ?? #UndiRosak

#UndiRosak - a movement predominantly amongst the young, spread via social media; aiming at registering a protest vote by intentionally spoiling their votes during elections

When I was younger, Malaysia was a country with hope. A middle-class that was growing, confident, capable, with a 'bring-it-on' attitude. We were regarded favourably by others both in our abilities and our reputation. We were attracting "talent" from outside from labourers to skilled experts. Children from surrounding nations came here to study. Yes, we lost many to the stars that shone even brighter then ie Singapore and Australia, but most left not because they could not do well here, rather because they knew their options as better elsewhere. We had ooomphh !

Today's Malaysia seems much more lost. The positivity of before has dissipated, our reputation now more of infamy, and people are leaving just to survive. We are pummeled by a constant onslaught of extremism, unfairness, one-sided views and marked polarity. The news of corruption and the stealing came in waves, until many couldn't stomach the local news anymore. The voices of reason, moderation, of consideration, and the voices on the ground, was either shouted down or stifled by censorship, and the drone of those in power kept the voice of the common man at bay. Middle-ground common-man Malaysia seems to have crept into the shadows, beaten into a disbelieving submission.

And in those corners, we are forced to confront ourselves with some difficult questions. Did I contribute to this state of affairs ? Could I have done something to prevent it ? Did I somehow just sit by and watch it happen ? Did my generation wreck Malaysia ?

I cannot believe that in the matter of 20-odd years we have lost all the good that Malaysia was. Yes we are a diseased tree. We probably need to lop off that rotten branch that is making us all sick. Remove those roots that is absorbing all that poison. Get rid of all those ants, bugs, rot and blights. The tree will still stand. Then it will repair itself, and it will start growing again. 

But things need to be DONE. Change requires action, work needs doing.

That's why I cannot understand #UndiRosak. Yes, I can understand a protest vote. Sure I can accept that both sides are far from perfect. We can hardly expect to vote between good and bad. More like between better or worse. Or at least some varying degrees of bad. If a protest vote was the aim, then get a candidate and run. Use the election to argue your point. Tell your plans. Describe your hopes and dreams for Malaysia, and I'm sure many many Malaysians will support that cause. We can surely use some hope and sunshine in that dark corner where we all are. Don't just say everybody's bad and SULK. That's what it is. Sulking, because your choice of menu was not on the table. You have a choice. Add to the menu. Say what you want. Inspire us. For all you know, for some sunshine, we may just bite.

So please let me share this after-thought with you. In another 20 years, when your youngest asks what you did then, when Malaysia was at the edge, how would you say that you #UndiRosak ?

On our behalf

In life, many times, things are done on our behalf. Our parents did most things on our behalf, and probably made important decisions for us through our early years (and sometimes even beyond our early years). That's okay, for parents always have our good outcome in mind. Along the way, elder siblings, the kind aunt or kay-poh uncle and your Mum's best friend neighbor probably weighed in a bit too. That too was probably okay. 

We would think that as we grew up, much fewer things would be done, on our behalf; that we would instead do more on our own, in our own way, to meet our own needs and desires, intentions and outcomes. But it may not be so.

And sometimes, we must think if these "on our behalf" actions is really to our own good. Or is it actually serving another. 

One of the biggest worries of actions done on our behalf is in politics. As a democratic nation, we pick people to represent us to formulate government actions. In the early years of democracy, politicians did represent the people. Their actions was guided by what the people wanted, individually, or at least for the greater good. But today unfortunately this is no longer the case - politicians represent themselves most of the time, their political party some of the time, and you almost none of the time.

They fight, quarrel, sometimes even create riots and fear purportedly in our name. They then govern as they wish because they claim to have been given the mandate to rule. (really? I thought they were given the mandate to represent us. Represent us is quite different from Rule us!) 

So, no more I say. We must at least take back some of our rights. At least, the right to decide. Then definitely the right for due process. The right for justice, fairness and transparency. The right to tell our politicians to bugger off when we want them to. 

We must take back ownership of our schools, our courts, our newspapers, our institutions, our nation. We must take back our minds ability to think for itself, our voices ability to speak for itself, and our hearts ability to love our fellow Malaysian for who they are, varied, different and yet similar. 

And we must never, ever again, ever allow bloody politicians to get away with so much, on our behalf.