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• SEMPER ET UBIQUE MEDICUS (physician always and everywhere)
  Guglielmo M. Trovato
  Published on: 23 March 2022

• Published on: 23 March 2022

  SEMPER ET UBIQUE MEDICUS (physician always and everywhere)

  • Guglielmo M. Trovato, Professor of Medicine The School of Medicine of the State University of Catania, Italy

  I read with great attention and not a little emotion the short article of Clinical Ethics by SDTR [1]. The narrative and flat form fails to hide the author's strong ethical commitment. Few points, in my view, deserve a greater focus in the challenging and highly contributing considerations.
  The core of this contribution is the question: “when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises”.[1]
  The issue is complex and is very much about the mutual assistance that patients (may) give each other, as have often given each other, when confined to a hospital ward, on a desert island, in a prison, in a concentration camp, in a college. This aspect of natural solidarity, observable also in ethology in many animal species, even in captivity, can come into brutal contrast not so much with "education", which concerns cultural and social aspects of shared ethics, but more with "instruction", also intended as training and usual professional activity. Actually, impact of curricular studies of medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease. [2] Are there deontological appropriate rules of conduct for doctors that can be immediately contrary to elementary ethics? Regretfully yes, and without dist...

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  I read with great attention and not a little emotion the short article of Clinical Ethics by SDTR [1]. The narrative and flat form fails to hide the author's strong ethical commitment. Few points, in my view, deserve a greater focus in the challenging and highly contributing considerations.
  The core of this contribution is the question: “when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical to intervene arises”.[1]
  The issue is complex and is very much about the mutual assistance that patients (may) give each other, as have often given each other, when confined to a hospital ward, on a desert island, in a prison, in a concentration camp, in a college. This aspect of natural solidarity, observable also in ethology in many animal species, even in captivity, can come into brutal contrast not so much with "education", which concerns cultural and social aspects of shared ethics, but more with "instruction", also intended as training and usual professional activity. Actually, impact of curricular studies of medicine on youngsters is complex, but seems to modify only some and limited aspects of previously acquired thoughts and feelings on health and disease. [2] Are there deontological appropriate rules of conduct for doctors that can be immediately contrary to elementary ethics? Regretfully yes, and without disturbing the best systems with our considerations. The recent year 2020, and the current 2021, however, is placing us in front of problems related to the confinement of entire populations, with extreme isolation both for hospitalized patients and for patients in home quarantine. Actually, even patients with COVID-19 are never completely alone, but those who have the fortune, or misfortune, of having to stay in the hospital in recent months find around them as the only possible friends, to watch and, hopefully, to talk to, other equally unhappy patients. Relatives, friends and even the personal doctor, if there is one, are not allowed in for visiting and even for contributing, as more or less was usual everywhere. The patient's only connection with the outside world is a functioning smartphone.
  Patients with COVID-19, or non-COVID-19 under current COVID-19 protective measures, stay alone in the hospital, and, at worst, die alone there. I do not want to talk about personal experiences, but I will only talk about the feelings of loved ones, or known ones or, simply, of my patients. The acute sense of injustice that patients and relatives feel concerns precisely this prolonged obligation to suffer and die alone.
  The most directly related issue is that younger doctors are trained to proceed along stranded guidelines, which do not at all include interference from other patients, however much they are medically qualified. In general, it can also be justified, by medico-legal considerations: but what leaps to the eye is the annoyance of many doctors in having a patient who is too aware, and sometimes too impatient or with excessive demands for attention. All this seems to be tolerated, and not always, if the concerns and requests, or suggestions, refer to the patient himself: less so if they concern other patients. Perhaps it is an anthropological problem, or perhaps something else, but this situation is at least unusual in the hospitals that I know. Here, as an unwritten rule, nurses and doctors often if not always ask for the collaboration of the concurrently hospitalized health professional to monitor, as possible, on other patients. As always, it is requested to the more lucid and attentive patients in the same ward. Intervening in the diagnostic reasoning, even in urgency, of those who are on-duty is, of course, quite another thing. However, it must be done, without hesitation, gracefully and promptly. Usually our trainees learn to appreciate this real world school. If all this sounds excessive and difficult to implement in a context of ethical directives, it could be better received within a strategy of clinical risk analysis and management, with a focus to processes.

  Guglielmo M. Trovato, MD
  Professor of Medicine at the School of Medicine of the University of Catania (Italy)

  References
  1) Taylor-Robinson SD. Personal perspectives: having the time to observe the patient. J Med Ethics Epub ahead of print: [please include Day Month Year]. doi:10.1136/medethics-2020-107041
  2) Trovato GM, Catalano D, Di Nuovo S, Di Corrado D. Perception of cultural correlates of medicine: a comparison between medical and non-medical students--the authoritarian health. Eur Rev Med Pharmacol Sci. 2004; 8:59-68. PMID: 15267119.

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  Conflict of Interest:
  None declared.

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