Paper presented to the freshman class Faculty of Medicine, National University of Malaysia on 9th June 2003 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH, DrPH, Deputy Dean Kulliyah of Medicine, UIA
1.0 HOLISTIC OUTLOOK
1.1 The model of Rufaidah: Rufaidah lived 1st century AH/8th century CE. She is an inspiration for the medical and nursing professions in terms of leadership, undertaking tasks, and community service. Her experience illustrates the ideal holistic world-view of a healthcare giver.
1.2 Leadership: Rufaidah had all the attributes of a good leader. She was kind and empathetic. She was a capable organizer able to mobilize and get others to produce good work. She had clinical skills that she shared with the other health care givers whom she trained and worked with.
1.3 Difficult tasks and missions: In peace time she set up a tent outside the mosque where she nursed the sick. During war she led groups of volunteers to treat battlefield casualties.
1.4 Community Service: Rufaidah did not confine her work to the clinical situation. She went out to the community and tried to solve the social problems that lead to disease by working as a public health nurse and a social worker. She came to the assistance of the poor, the orphans, or the handicapped. She looked after the orphans, nursed them, and taught them.
1.5 The human touch: Rufaidah had a kind and empathetic personality that soothed the patients in addition to the medical care that she provided. The human touch is a very important aspect of medical care that is unfortunately being forgotten as the balance between the human touch and technology in nursing is increasingly tilted in favor of technology.
2.0 RESPONSIBILITY
2.1 Responsibility to the patient: In addition to providing excellent technical care, the physician is responsible for ensuring overall psycho-social welfare of the patents and their families as much as possible. This includes making sure that patients have universal access to affordable care irrespective of the socio-economic conditions.
2.2 Responsibility to the community: The physician is a powerful person in society. He can play a leading role in moral uplifting, encouraging virtue, and fighting unhealthy lifestyles. He can play a leadership role on issues that are of public concern such as the environment, human rights, and peace. He can advocate for the poor, the weak, and the deprived.
2.3 Responsibility to medical science: The physician has a duty to undertake research in order to push forward the frontiers of knowledge. Medical practice must be based on new knowledge that is produced by constant research. Publication and teaching disseminate medical knowledge.
3.0 LEADERSHIP
3.1 Community Leadership:
A physician should exercise social responsibility and social leadership. He must be an ethical leader with the courage to change and improve society. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. He can lead when in the community and not the hospital. Inside the four walls of the hospital the physician acts as a technician and not a leader.
3.2 Moral leadership:
The physician is a respected opinion leader. His moral values, attitudes, akhlaq, and thoughts must be a model for others. An ideal physician must be a moral example to others by having the following characteristics: iman, taqwah, amanat, and akhlaq, devotion to duty, honesty, and compassion for the poor and the weak. It is not enough for the physician to show a good example but she should also call others to be morally upright.
3.3 Leadership on medico-ethical issues:
The physician should give leadership to patients on ethical issues that arise out of modern medical technology. He must understand the medical, legal, and ethical issues involved and can explain them to patients and their families. As ethical leaders physicians should identify and root out all unethical practices in medical practice and research.
4.0 CHOICE OF A MEDICAL CAREER: GREED vs SERVICE
4.1 Motivation for a medical career: The motivating factors range from the idealistic to the pragmatic material rewards. Students are idealistic on entry into medical school and talk about studying medicine to serve the community. Towards the end of their education, many students talk about benefiting from their education to find a job, enjoy easy life and have a high social status.
4.2 Material benefits and service: Material motives cannot be completely ignored in the name of idealism. A minimum of comfort is necessary for the practice of virtue. The physician should be recompensed adequately for his services. Inadequate material rewards often result into frustration or even brain drain when young physicians leave the medical profession, refuse to work in rural or depressed areas, avoid unpopular but necessary specialties. The physician working in a materialistic society is torn between contradictory forces of greed and service. Service should have the higher priority but the material rights and privileges of the physician should not be forgotten because he also wants to live a happy life.
4.3 A career in academic medicine: Students with the necessary competence and drive are encouraged to choose a career in academic medicine because it combines research, service delivery, and teaching. It is the best opportunity to serve the community. Research combined with patient care fulfils the Prophetic guidance to look for useful knowledge, ilm nafei, that relates directly to existing medical problems. A researcher who is a teacher will always have something new and interesting to share with the students. His teaching will be exciting and students will look forward to it. The right balance must be established between research and teaching and between teaching and patient care.
