The Challenges Facing Physicians World Wide
Dr. Delon Human
Secretary General of the World Medical
across the world are facing increasingly complex and demanding problems in
delivering health care to their populations. And as they struggle with the
solutions, physicians are coming under new pressures that could determine the
future role of the medical profession globally.
As the world becomes more of a global village, so the influences and pressures
which physicians all over the world are encountering are converging.
Whether it is in highly developed countries such as the USA or in western Europe
or in the developing or under developed world, these pressures have a common
I have identified five clear global trends now facing individual physicians:
the inability of public sector health care systems worldwide to cope with
demand for health care services and in response to that, the expansion of the
private health care sector;
a movement towards preventive health, where, because physicians are reluctant
to take the lead, nurse practitioners and pharmacists are being offered an
opportunity to expand their professions;
a definite shift towards measurable quality. Driven by patient-demand for
outcomes-measurement, especially in the USA and UK, there has been an increase
in sophisticated systems of professional self-regulation. If doctors do not
get their own act together, somebody else will;
a significant shift from an unmanaged fee-for-service system, where private
health care services are provided, to one where costs are managed.
the increasing role of technology in medical practice.
phyisicians face up to these pressures, I believe that they will begin to lose
threat to the medical profession and to the patient is that clinical
decision-making will eventually be forced into a situation of financial
decision-making, which could cause irreparable damage to the patient-physician
My concern is that the medical profession
might not be focused enough on its core duties to be able to be effective
medical and social leaders.
Physicians will increasingly be more subject to
international political influences in health care. Governments will manipulate
change with the emphasis on universal access to health care, cross-subsidised
funding and the additional emphasis on the preventive and promotional elements
of primary health care.
My warning to doctors is to guard against being branded as a self-serving
profession. If physicians worldwide do not stay on the high road of being the
patient’s best advocate and partner in health, they will suffer.
I believe that in response to the five global trends I have set out, physicians
must defend vigorously their fundamental ethical principles in the following
they should always treat patients as they themselves would like to be treated,
and put the patient’s interests above their own.
The patient-physician relationship is unique within the health care
professions, and I believe it is the single most important competitive
advantage our profession has. Patients generally trust us - and we shall
literally lose our profession if we lose that trust;
they should maintain a position of technical and moral independence, so that
it is never necessary to make decisions against their conscience and not in
the best interest of the patient;
the patient should always have the right to choose their own physician or
change physicians if necessary.
This will enhance confidence and trust, not diminish it;
medical confidentiality should remain a basic principle of medical ethics;
the physician has a duty to protect the rights and interests of the patient at
the level of public health.
believe that physicians world-wide must re-establish their role as the central
leader of the health care team and chief caretaker of our patients by
strengthening our knowledge and understanding of the medical art/science, by
improving our clinical skills and by paying much more attention to skills of
communication. A strong international culture of continuing medical education is
a prerequisite for this ideal.
In addition to their role in curative medicine, physicians should expand their
clinical horizons by participating much more in the prevention of illness and
the promotion of health. This includes areas such as rehabilitation or the care
of the handicapped and terminally ill.
To manage change, physicians have the capacity to be both the most knowledgeable
specialists and the most gifted generalists, not only in the medical field but
also in the socio-economic and management spheres. Apart from sound knowledge
and skills, the integrity and ethical nature of our profession are the most
important benefit and assurance we can offer our patients.
The most important criteria of a sound health care system are not the number of
physicians, nurses or hospitals in a country. Rather it is basic socio-economic
indicators such as the per capita level of income and the level of education in
a country. Physicians are not involved enough in these political areas, which we
can do effectively as individuals or in a collective manner.
If physicians do not speak up and become involved as social leaders, be sure the
politicians will plan the system around them.
The autonomy and knowledge of patients have changed significantly over the last
few decades. Where in the past the medical profession has acted in a somewhat
paternalistic manner, the new patient-physician relationship is much more of a
partnership. Again the only threat to the physician is non-adaptation to what I
consider a very positive change in the levels of knowledge and choice for our
the world, national medical associations are focusing more and more on the
issues of patients rights and safety.
things never change, especially regarding the core role and function of the
physician. Hippocrates, regarded as the father of medicine, lived from 460 to
377 B.C. He taught us to first do no harm when treating patients, to respect and
protect life and to maintain the confidentiality and justice of the patient. It
is remarkable that most of those ethical principles are still applicable today.
Even the World
Medical Association used the Hippocratic oath as the basis to develop the WMA
Declaration of Geneva, which is used by some medical schools during the
graduation ceremony of their young physicians. Likewise, the WMA Declaration of
Helsinki, which is a statement of ethical principles for medical research
involving human subjects, contains many principles outlined in the Hippocratic
Without doubt we can say that these principles of the past have not changed.
The WMA, which now represents some seven million physicians of all specialties
and sectors from at least 80 countries, has as its main goals for the medical
profession the need to attain the highest standards of medical ethics,
professional standards, medical education and the best possible treatment of our
The medical profession is approximately 2500 years old.
If we wish for a future where our patients have access to high quality health
care services and medicine, and where physicians can provide medical leadership
and care in an ethical, professional, independent and interdependent manner,
physicians urgently need to become involved in managing the good and the bad
sides of health care.
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September 17, 2002