Paper presented to the freshman class of the Faculty of Medicine Islamic University Bandung on 21st July 2008 by Dr Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Professor of Epidemiology and Islamic Medicine Institute of Medicine University of Brunei and Visiting Professor of Epidemiology University of Malaya
ABSTRACT
This paper discusses the personal characteristics of an ideal Muslim physician. An ideal Muslim physician is a multi-dimensional character described as having iman, taqwah, amanat, and akhlaq. He will require Islamic motivation to cultivate and maintain this character as a student and as a future physician. The medical education system must be set up to help guide the student to this ideal character.
1.0 CHARACTER OF THE IDEAL MUSLIM PHYSICIAN
1.1 Iman
Three aspects of iman bear directly on medical practice: tauhid, qadar, and tafakkur. The integrating paradigm of tauhid enables the physician to practice integrated and balanced medical. Such care combines Islamic values and Islamic law with the best available in advanced medical technology. Belief in qadar guides the physician in his work to know and understand that life, health, illness, and cure are in the hands of Allah. He will understand that he is a tool and not the reason for the cure. He will realize that the physician has limited knowledge and limited ability and should not be arrogant. After doing all what is humanly possible for his patients, the believing physician trusts in Allah's help and support. A believing physician will know that he cannot change the time of death, ajal, since that is under Allah’s direct control. He will concentrate on improving quality of remaining life for his patients. As the believing physician goes about his daily chores, he undertakes contemplation, tafakkur, about all what he sees. Medical knowledge and actual clinical experiences increase iman because the physician realizes the power and majesty of Allah who created the complex human organism and who cures it from the most severe diseases.
1.2 Taqwat
A believing physician is conscious that Allah is watching and is ever-present. He knows that other humans observe his actions. He will do well in public and private. He will strive to know the permitted, halal, and do it. He will even more intensely strive to know what is prohibited, haram, and avoid it. He will avoid being involved in prohibited medical procedures that result in destruction of life such as abortion, euthanasia, and assisted suicide. He will keep away from fraud, false evidence, lying and misrepresentation. He will not dispense forbidden, haram, medication.
1.3 Amanat
A believing physician will take his medical work as a trust, amanat. The trust involves three dimensions: commitment and sincerity of intentions, ikhlas al niyyat; quality work, itqan & ihsan; and the social responsibility of both da’awa and being a role model, qudwat. A sincere intention increases commitment. Medical practice is ‘ibadat for the pleasure of Allah. Medicine is also a form of charity. The motivation of the physician should therefore be service and not personal enrichment and material gain. A believing physician will try to excel in his clinical responsibilities by making sure that he tries to achieve perfection, itqaan, and excellence, ihsaan. Professional competence cannot be compromised in any way. It is a major sin to undertake any medical procedure beyond the level of competence of the physician. A believing physician knows that he is accountable before Allah, the profession, and society at large. He will discharge his duties honestly using the highest standards of good medical care. He will avoid harmful, doubtful, or unnecessary treatment. He will strive to have regular updating of his knowledge and skills. He will engage in research for new and better treatment modalities; every disease has a cure. A believing physician will know that he has societal responsibilities beyond the treatment of disease. He will use any opportunities available to make dawa to patients and their relatives. He will work to eradicate or alleviate social root causes of disease. In his personal life he will strive to be a role model of good character and behavior for the rest of society. He will not shy away from social leadership and advocacy for the less privileged or the oppressed.
1.4 Akhlaq
The physician must have humility, tawadhu’u, show brotherhood, ukhuwwat, and have social respectability, muru’at. He should show humility to Allah, to professional colleagues, to patients and their relatives. He should avoid show-off, riyaa, in its manifest and hidden forms. Brotherhood is manifested in the humane treatment and respect for all patients regardless of their disease and social status. The believing physician gives reassurance, empathy, consolation, psychological support for patients and relatives. He has a positive and optimistic attitude in the stress of illness. He also fulfils the basic duties of brotherhood with his professional colleagues. Social respectability is acquired by good public behavior and avoiding any negative behavior that violates this respectability, khariq al muru’at. This should not be a mere show or acting in public when in private behavior is despicable. It must be sincere and consistent with an overall good behavior.
2.0 MOTIVATION
2.1 Concept and methods of motivation in Islam
Motivation can be intrinsic (self motivation), extrinsic (motivation by external rewards), or reactionary (temporary response to events). Jannat is a positive motivator. Jahannam is a negative motivator. Motivation starts with commitment to an intention Ikhlaas al niyyat. The reward for work is commensurate with the niyyat. Any work without niyyat is not recognized. The best of work is consistent and continuous. Work can be good work, ‘amal hasan or bad work, ‘amal sayyi. High job satisfaction is directly related to high motivation. Motivated workers know that work is ibadat and that Allah observes all they do so they strive for excellence, ihsaan. The salary meets the needs of the worker and family so that he can devote time and energy to the work and is not a just return for the work. Work is ‘ibadat and only Allah can recompense for it. Other sources of motivation are honor, sharaf, generosity, karam, and fulfillment, wafaa
2.2 Motivation in the medical profession
Students are idealistic on entry into medical school and talk about serving the community. On graduation many students think about material benefits and social status. A physician in a materialistic society is torn between contradictory forces of greed and service. Although service should have the higher priority, the material rights and privileges of the physician should not be forgotten because he also wants to live a happy and honorable life.
2.3 Motivation and responsibility
A physician is a community leader who has to undertake tarbiyyah, amr bi maroof, and nahy al munkar. He is an advocate for the poor, the weak, and the deprived. He has to undertake research to push forward the frontiers of knowledge. He has to share his knowledge by teaching others. He has responsibility to the environment and posterity.
2.4 Early Muslim physicians as a motivator
Ancient Muslim physicians were encyclopedic in knowledge, all-rounded, motivated, hardworking, and productive. They excelled in medicine as committed Muslims because Islam is not incompatible with science. Their achievements are a motivator for today’s medical students and physicians. Abubakr Al Razi (251-313H), wrote more than 100 books (the most famous being al Hawi al Kabir), investigated diseases (gynecologal, obstetrical, hereditary, eye, small pox, and measles), discovered surgical sutures, used anesthetics, used ammonia to control diarrhea, considered psychological factors in disease treatment, and was director of hospitals in Baghdad and Rayy. Ibn Sina (370-428H) wrote many books (the most famous being al Qanuun fi al Tibb), recognized that TB was contagious, accurately described the symptoms of diabetes mellitus, discovered ancylostomiasis, and contributed to science, mathematics, chemistry, and philosophy. Al Zahrawi (d. 404H) had interest in surgery, pharmacology, and anatomy. He designed over 200 surgical instruments. His book Kitaab al tasriif, became a standard textbook of surgery. He was an expert in cancer surgery and tooth extraction. Ibn Zuhr (d. 487H), lived in Andalusia and Morocco and authored the book al Taysir translated into Latin and used in Europe. Ibn Rushd (d. 595H) was a philosopher and a medical practitioner. His book al Kulliyat translated in Europe. He made the observation that smallpox infected only once. Ibn Al Nafees (d. 686H) described blood circulation before William Harvey and authored Sharh tashriih al qanuun in which he explained pulmonary circulation.
3.0 MEDICAL EDUCATION, ta’alim al tabiib
3.1 Medical education: content and issues
Medicine is closely associated with all the 5 purposes of the Law: diin, nafs, nasl, aql, & maal. Study of medicine is therefore fardh kifayat. Medical students should learn basic and clinical sciences, the essentials of Islam, al ma’lum fi al diin bi dharurat, ahkam fiqhiyyat relating to medicine, and the social background to disease causation and prevention. There are 6 conceptual issues in medical education from the Islamic perspective: purpose of medicine and medical education, integration, balance, service, leadership, and research.
3.2 The issues of purpose, integration, and balance
The purpose of medicine is to restore, maintain or improve the quality of remaining life. It cannot prevent or postpone death because ajal is in the hands of Allah. The aim of medical education is producing physicians whose practice fulfills the 5 purposes of the Law within a holistic tauhidi context. They will have the following characteristics: health and not disease oriented, focused on quality and not quantity of life, humble to recognize limitations to their abilities, holistic in outlook, understand society, scientific capability, clinical expertise, and leadership. European secular-oriented medicine is fragmented by organ, disease process, and is not holistic. Islam can provide an integrative tauhidi paradigm to replace the European non-tauhid world-view that is atomistic, analytic, and not synthetic. In the absence of an integrating paradigm, European medicine lacks balance and equilibrium in its therapeutic approach. The Qur’anic concepts of wasatiyyat, mizaan, i’itidaal, and tadafu’u provide a conceptual framework for balanced medical practice.
3.3 The issue of service
Medicine should be taught as a social service with the human dimension dominating the the biomedical dimension. Medicine should be practiced as of mutual social support. Medical education should prepare the future physician to provide service to the community. This will require skills of understanding and responding to community needs that can be acquired by spending part of the training period in a community setting away from the high technology hospital environment.
3.4 The issue of leadership
The medical school curriculum and experience should be a lesson in social responsibility and leadership. The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health. The physician as a respected opinion leader with close contact with the patients must be a model for others in moral values, attitudes, akhlaq, and thoughts. He must give leadership in preventing or solving ethical issues arising out of modern biotechnology. He must understand the medical, legal, and ethical issue involved and explain them to the patients and their families so that they can form an informed decision. He should also provide leadership in advocating for the less privileged and advocacy for human rights.
3.5 Reform of medical education
Admission decisions should in addition to academic competence consider comprehensive holistic approach based on tauhid, a service vocation, ethical and community leadership, and motivation to get knowledge. The medical school curriculum should be reformed in 2 ways: (a) more methodological content and less biomedical information (b) learning by apprenticeship by early involvement in patient care. The future physician must be a producer and not a consumer of knowledge. This will require giving more time to basic research methodological tools and decreasing the amount of biomedical scientific information that is either forgotten or becomes obsolete by the time of graduation. Student research projects are a good introduction to life-long curiosity in science and discovery. Besides facts and skills, students learn values, attitudes, and assumptions from their teachers and the environment. For apprenticeship to succeed the teachers must be good models and the ambience must be Islamic.
