Study on the Attitude of Medical Practitioners towards Medical Practice through the lens of Social Accountability- Enlightening Asian Perspective to Curtail Social Crimes

Prof Dr. Anjum Bano KazimiMunir Moosa Sadruddin

Rationale• Ali & Baigh (2012) shared that the state of

social accountability in Pakistan is weak. The medical institutions are not showing up their social concern to address this need (Baig, 2011). Medical professionals are not showing accountability towards society which has increased social crimes due to involvement in malpractices (Dawn, 2013). One of the portrayals of such negligence is lack of knowledge and attitude of medical practitioners towards social accountability.

Rationale• The code of ethics, defined by Pakistan Medical and

Dental Council (1960) is the sole document which provide medical codes and conducts to the professionals in Pakistan. Since the turmoil among medical practitioners is mounting in Pakistan due to socio-economic and political attachment, and no research in Pakistan has so far been conducted to find the attitude of medical practitioners towards their social responsibility, the dire need to find the trend of medical practitioners towards social accountability was felt

Objective

To investigate the attitude of medical practitioners towards social accountability

To find the knowledge level of medical practitioners towards social accountability

To investigate practices of medical practitioners which are linked to social accountability

Methodology

• The current study adopts survey methodology, which is justified on the fact that the researchers wanted to gain knowledge as well as attitude of individual unit, i.e., doctors.

• Mix method (survey method & phenomenology) is used to gain data.

Population and Sampling

• The population for the study consist of all the doctors serving public or private hospitals.

• Multi-stage sampling is used to derive n=120 doctors. Doctors are selected through snowball sampling, whereas proportionate sample was used for equal representation of either gender. In the second stage, convenient sampling is used to collect qualitative data from 10 doctors for data triangulation

Sampling Structure

Snow Ball Sampling Convenient Sampling

N=120 N=10

N=120

Multistage Sampling

Survey Method Phenomenology

Research Instrument

• Questionnaire was designed, keeping in view the document of code of ethics, designed by Pakistan Medical and Dental Association, Pakistan. Semi-structured interview questions were designed for interview. For ethical consideration, the respondents signed consent letter.

• The content validity and reliability was tested through test-retest method, which was found to be satisfactory.

• 48 items were designed. Panel of experts gave suggestions. It was further modified and was piloted on the sample of 30 doctors. Final items selected were 28, which were validated through content validity while made reliable through checking internal reliability.

Validity and Reliability

Stage

Quantitative Data •Survey Questionnaire•Quantitative Data Analysis

Qualitative Data •Phenomenology•Qualitative Data Analysis

Data Triangulation

Data Analysis Procedure

• Quantitative results are analyzed statistically using tables and one-tailed chi-square test, while qualitative results are analyzed using phenomenology.

Generalization

The results reveal that the attitude of medical practitioners towards social accountability varies. Their knowledge is average but their attitude not much inclined towards positive domain. The researchers suggest the inclusion of social accountability as a compulsory component of medical curriculum besides providing timely training to doctors towards social accountability.

Results

• The knowledge level of the respondents towards social accountability is average, however their attitude towards social accountability varies.

• All the respondents are affiliated with some medical or social organization.

• No trainings on social accountability were attended by the respondents for the past 5 years.

Results

• Half of the sample shared that topic of social accountability is included in the curriculum of MBBS but the theory has not turned into practice.

• Doctors shared that they keep up-to-date knowledge about medical ethics, however during interview it was revealed that they use newspapers and internet to gain knowledge about global medical ethics, but have not gain much information on local platform.

Results• There is a missing gap of privilege

communication due to lack of knowledge and willingness and concern towards alerting higher authority, particularly the cases of food poisoning was not taken into consideration at large scale.

• A very high ratio of professionals considered their responsibility to share correct medical information to the relatives and the patients. Regarding malpractices, majority said that it is not their duty to report malpractices of colleagues to higher authority.

Results

• During interview, one of the respondents shared that they prefer avoiding such issues due to good terms with the colleagues and to secure their job.

• Higher number of respondents agreed that they receive special favors from medical raps and prefer medicines to the patients on the basis of rapport build with medical raps, however, doctors try not to prescribe expensive medicines to the patients.

Results

• In response to question about female patients whether they should be given consultation only by female doctors, majority of the respondents agreed. When asked about discloser of gender of the fetus, majority disagreed but a large number of respondents showed inclination towards disclosing gender of fetus on the basis of personal relation.

Results• It was expressed by half of the respondents

that they never send or submitted their pledge paper of ethics to their college which is compulsory to get their degree. It shows a less emphasis on this area.

• Knowledge and attitude related to displaying their registration number and service charges is rarely followed which makes ways for malpractices, over changing and corruption in health sector that must be strictly deal by related controlling authorities.

Results• From the interviews, it was also revealed that though

the respondents do not favor politics, but for the sake of their rights, they prefer raising their voice.

• For prescription, majority of the respondents said that presence of patient is not mandatory for the issuance of prescription. Majority do not prefer using layman language to express their views and providing medical suggestions to the patients and their relatives.

• Majority do not display registration number and fee structure. The respondents consider strike as their right to achieve demands. Majority do not disclose matters related to legal compulsion about criminal attempts like abortions, suicide, and concealed birth.

Results

• Overall, majority has appropriate knowledge about social accountability but young doctors show least concern about several issues which include code of ethics.

Recommendation• Ongoing refresher courses should be introduced• Researches should be disseminated to the doctors for ongoing

learning• Present curriculum of medical education needs to be revamped

and updated in both the content and delivery• Stopping mushroom growth of medical universities and

colleges • Universities and colleges of medical education should act in a

protagonist manner towards the vision and mission of code of ethics

• Code of ethics should be an active part of curriculum that must reflect in practice

• Compulsory community services of certain duration should be the part of practical training

Beneficiary

• Medical Colleges and Universities• Medical Teachers• Ministry of health sciences