Playing above the Rules: Media and Doctors
By Dr Mohammad Taqi
Florida
‘Mistakes live in the neighborhood of truth and therefore delude us.’
(Rabindranath Tagore in Fireflies)
What transpired two weeks ago, between the media-men and doctors, at Lahore’s Jinnah Hospital, is an ugly blemish that would require robust and sustained societal action to be washed.
Two groups of professionals were literally at each other’s throat, shredding in the process their respective codes of ethics.
As I watched this brawl on a Pakistani television channel during my lunch hour, I happened to have a medical student with me. As the son of a working journalist, a freelance op-ed contributor and a practicing physician myself, I found myself torn and humiliated when my student asked as to what was going on. All I could mumble was that some of us like to play above the rules.
My mind then turned to the late CP Scott’s golden rule for newsgathering that "a newspaper's primary office is the gathering of news. At the peril of its soul it must see that the supply is not tainted."
Well, could the newsmen on the Jinnah Hospital beat then safely say that the information they gathered was not tainted? Not tainted by the breach of editorial code that any media outlet worth its salt should have in place.
CP Scott’s The Guardian clearly states in its editorial code regarding the hospitals that:
i) Journalists must identify themselves and obtain permission from a responsible executive before entering non-public areas of hospitals or similar institutions to pursue enquiries.
ii) The restrictions on intruding into privacy are particularly relevant to enquiries about individuals in hospitals or similar institutions.
The Guardian’s code also cautions against use of clandestine devices and subterfuge, stating that:
i) The press must not seek to obtain or publish material acquired by using hidden cameras or clandestine listening devices; or by intercepting private or mobile telephone calls, messages or emails; or by the unauthorized removal of documents or photographs.
ii) Engaging in misrepresentation or subterfuge, can generally be justified only in the public interest and then only when the material cannot be obtained by other means.
All readily available references on professional ethics in journalism emphasize the respect for privacy and human dignity as an integral part of the professional standards of a journalist.
From what has appeared in the media, it is difficult to say if any of the journalists involved would be able to vouch that their reporting in this case was not tainted.
There is no doubt that the news media – especially the electronic media - has the power to mould the society’s perceptions of health care issues, including the medical errors and negligence. But turning patients into public curiosity, misery into headlines and public shaming of the doctors to the point of coercion, cannot achieve this.
When the late Aziz Siddiqui pioneered the Frontier Post from Peshawar, he made the copies of “The Times Style Guide” and ethics code available to the members of his team. A generation later, we have taken a step back to the Tehlka.com mode of sensationalism. We are about to let the mistakes living in the neighborhood of the truth delude us.
The spat of violence against the doctors, booking them under section 302 of the Pakistan Penal Code, slapping anti-terrorism charges against them under the full glare of tele-media is not only putting the doctors in the “fight or flight” mode but also keeping the media from focusing on what is called the “culture of safety” in modern practice of medicine.
The ad nauseum repetition – mostly by the media - of the Urdu/Arabic word “maseeha” for the doctors creates a halo of infallibility around them. We are not infallible and the medical science is far from being perfect.
The doctors – like any other human- make mistakes and the practice of medicine is fraught with potential for errors in the diagnostics, treatment, prevention, and communication or due simply to dealing with the unknown. Death or injury is not always the failure of medical science but many a time is an inevitable outcome.
In 1999 the Institute of Medicine - the health arm of the US National Academy of Sciences - published its landmark report, “ To Err Is Human : Building a Safer Health System”, about breaking the silence surrounding the medical errors and their outcomes. From the outset, the report made four issues abundantly clear.
First and foremost was that the report itself, and the health care system, were a decade too late compared to any other high-risk industry to pay attention to ensuring basic safety.
Secondly, it observed that nothing short of a national agenda involving national and state governments to be implemented within and outside the health care organizations, through the regulatory and incentive-based and public and private strategies, would make a significant dent in the problem which at the time was contributing to at least 44000 deaths per year.
Thirdly, it advocated setting quality benchmarks and standard of care metrics along with promoting trained leadership, creating research and assessment tools and setting up voluntary and mandatory systems of error reporting.
The most important conclusion of the report was that in majority cases, the medical errors are not the result of individual recklessness or incompetence. Most commonly the errors result from systemic failures, faulty processes and an absence of safety nets. A key observation was that unless the culture of pointing fingers at the individuals was abolished, it was difficult to promote the culture of safety.
Ten years on, many of the recommendations of the Institute of Medicine have been implemented across the health care systems in the USA while others are being rolled out and improved upon.
While the media’s job is untainted newsgathering and balanced reporting, the doctors’ pledge is to first do no harm but also to honestly report and try to mitigate such harm in the event it happens.
However, the physicians’ community is lagging behind by decades in developing strategies even to recognize the magnitude of the crisis where unintended harm or negligence leads to adverse outcomes.
In Pakistan, the media and the doctors have an opportunity to turn this moment of adversity into opportunity to educate the people and the lawmakers about developing a culture of safety throughout the health care system. But if they decide to continue playing above the rules, history may judge them harshly for being part of the problem.
As for those of us outside Pakistan, we can pledge our professional, scientific and academic resources to help keep the mistakes lurking near truth from deluding all of us.
(Author teaches and practices Medicine at the University of Florida and contributes to think-tanks www.politact.com and Aryana Institute. Email: mazdaki@me.com )
