In all areas you learn using study material. Painters with canvases and paints, writers with paper, pencils, and erasers, carpenters with woods and saws, environmentalists exploring rainforests and measuring the concentrations of various substances in the environment. With veterinarians and doctors the situation differs: they learn thanks to living beings, or, to put it in precise words, using living beings. Although ethics have begun to permeate these areas, there is a lack, and always will be, much to do. Not all veterinary schools nor all hospitals have academic committees whose mission is to regulate the activities of physicians and veterinarians.
I do not know if there are monuments or iconic figures of dogs, parrots, elephants or human beings to recognize and honor their work – I wrote work – as part of the process of teaching young aspirants and even teachers. Despite my ignorance, I am convinced that the tribute paid by the medicine to the sick it has been meager if not zero, without forgetting the inhuman use of sick people and animals as experimental subjects.
In one of the memorable passages of The fish of Camus, a novel now in vogue due to the coronavirus, the doctor Rieux, central character of the plot, to the question, “Where did you learn so much, doctor?”, he responds, “of suffering.” In the process of teaching the medicine, the sick occupy the first place. Then the professors follow, especially those who teach the profession next to the patient and not only reviewing laboratory or radiology tests. The next steps are occupied by technology and the laboratory; sadly, their omnipresence has blurred the importance of the person.
Painting and guitar apprentices have their first encounters with canvases to paint and strings to play with, while medical students exercise their first maneuvers, pricking a vein or receiving a baby, with human beings. The same happens with hospital institutions: they test their new gadgets on sick humans. In both instances the old proverb “to err is human” applies, but as you read the lines ahead, “to persevere in error is diabolical.”
The above questions are not easy. Two ethical concerns dominate the stage. First. Do patients have the right to know, especially in hospitals where teaching is the leitmotif, who is the doctor who performs the procedure? Second. Do hospitals have the obligation to explain to patients that they will be the first to use the new device? From ethics and valuing the autonomy of each person, the answer is yes. However, in practice, and especially when the paternalism and where the empowerment of patients does not exist, patients do not usually receive, if it ever happens, such information. The obvious solution is to share the situation with patients and assure them that students will be accompanied by experienced staff, although, in times of pandemic, A truism dixit, it is impossible to stop and explain to patients the need for informed consent, the importance of which is increasing: “procedure by which it is guaranteed that the subject has voluntarily expressed his intention to participate in research, after having understood the information that has been given about it, the benefits, the inconveniences, the possible risks and the alternatives, your rights and responsibilities ”.
Said guideline, informed consent, should be expanded and applied when maneuvers such as those described are performed on the patient. Patients are teachers; doctors grow thanks to them and technology depends on them.
Doctor and writer