Idealistically Realist

the north coast of Java island, taken during my last week trip to Central Java

"Do you know what's the secret of being a popular doctor?" my father asked, just recently.

"What is it?" I shrugged.

"Give your patient the most potent medicine. Once they know the drugs work well, they'll know that you're doing your job."

My father, a businessman, is now working in tobacco company (yes, that's how he make a living for my family and me, maybe an irony for some of you). But that's life, I can spend the whole day explaining how dangerous tobacco is for health and at the same time I can't find a new job for him. I can say how statistically cigarette smokers have higher risk for lung cancer, but at the same time some of his clients, owners of small cigarette factories who have smoked for most of their lives, managed to live until their 70's. While some of the "healthier" ones died on younger ages.

And one day, me and my father engaged in another what seemed to be endless conversation, about drug prescriptions. There is a doctor who is working in a private clinic near my father's house, and everybody in the area knows how crowded the clinic is during practice hours. My father said that the doc is being smart, he provides the drug for the patients so they don't need to visit the drug store and most of the drugs he prescribed is quite affordable. More efficient and cost-saving for the patient, popularity-boosting for the doctor. Sounds so ideal from a businessman's point of view.

Me, on the other hand, didn't have the same thought. We, medical students, have been taught not to "sell" the medications by ourselves, as it is not ethical for our profession. And I know that giving the most potent medication can't be applied in any patient's case. This is related to antimicrobial resistance, drugs' long term side effects, and giving reasonable treatment. For example, we can't prescribed the most potent antibiotics for just a simple diarrhea. Or giving various combination of analgesic for long term usage before we know the main disease. It's like shooting an annoying mosquito with a bazooka. The mosquito will die, but is it necessary to blow your house just because a single mosquito?

I tried to explain what I've been taught about in medical school to my father. The medical ethics, pharmacology, and all. But in the end, he replied, "The fact is, there are some well-known doctors doing so."

Yes, in the end life is all about choices. I can choose my ideal theoretical knowledge, or the fact that I can't make huge amount of money in a short time by doing the right thing. We, as patients, also have the right to choose and ask about the proper medication we get. It's about dealing with our health holistically and for long term, not just the disease itself. The medical students have been taught all the right thing about prioritizing our patients' life, and not the amount of money we can add to our bank account. But the real life happens outside the medical school, where the choices are made.

I do believe that patients have the right to ask to their doctor, about the disease, about the reason why they choose to prescribe certain medication, the side effects and the desired outcomes of the treatment, and if the treatment may affect their health in general. Doctors are also have the right to look after the disease or the chosen treatment based on updated references, talk and explain more to the patients, making differential diagnosis and plan for further/additional examinations, giving prescriptions based on every consideration, no single medication is perfect but it is given based on each patient's condition, with their own characteristics.

I babbled much, eh? Well, but the fact is, as for now, I am not yet a doctor.

 

(This post is not about judging either patients or doctors, it is merely based on my personal thoughts and can't be applied to every medical conditions.)