Professionalism and the medical student

• Published in: The Lancet (British edition) Vol. 364; no. 9446; pp. 1647 - 1648
• Main Author: Francis, Charles K
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 06.11.2004; Elsevier Limited
• Subjects: Bioethics; Communication Barriers; Ethics, Medical; Health care; Health Care Rationing; Humans; Patients; Professional ethics; Quality of Health Care; Safety; Social Responsibility; Students; Transients and Migrants; Bioethics and Professional Ethics
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(04)17370-4

For the medical student in this essay, the primacy of his patient's welfare was a driving force. The student offered the only things he had as a student-"my time, my ear and my voice" for the benefit of his patient. The principle of patient's autonomy, empowering informed treatment decisions, presented special challenges in this patient's care, mainly because of language and cultural barriers. The student wondered whether this 70-year-old man would have elected dialysis, kidney transplantation, or nursing-home placement if he had fully understood his predicament and was able to make decisions about his care. However, the student's most difficult struggle is with the principle of social justice, which urges physicians to work actively to eliminate discrimination in health care and to assure fair distribution of finite resources. The student's patient, an uninsured illegal immigrant, raises thorny questions about the just distribution of finite health-care resources. In our society, health professionals are faced with a seemingly paradoxical choice between the primacy of each patient's welfare, individual patient's interests are most important, and the fair distribution of limited overall resources, which must respect societal resource limitations.