|Year : 2016 | Volume
| Issue : 7 | Page : 89-93
Knowledge, awareness and practice of ethics among doctors in tertiary care hospital
Surjit Singh1, Pramod Kumar Sharma1, Bharti Bhandari2, Rimplejeet Kaur1
1 Department of Pharmacology, AIIMS, Jodhpur, Rajasthan, India
2 Department of Physiology, AIIMS, Jodhpur, Rajasthan, India
|Date of Submission||30-Aug-2016|
|Date of Acceptance||06-Oct-2016|
|Date of Web Publication||2-Nov-2016|
Pramod Kumar Sharma
Department of Pharmacology, AIIMS, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: With the advancement of healthcare and medical research, doctors need to be aware of the basic ethical principles. This cross-sectional study is an attempt to assess the knowledge, awareness, and practice of health-care ethics among health-care professionals.
Materials and Methods: After taking written informed consent, a standard questionnaire was administered to 117 doctors. No personal information was recorded on the questionnaire so as to ensure the confidentiality and anonymity of participants. Data analysis was done using SPSS version 21 (IBM Corp., Armonk, NY, USA).
Results: Statistically significant difference observed between the opinions of consultant and senior resident (SRs) on issues like, adherence to confidentiality; paternalistic attitude of doctors (doctors should do their best for the patient irrespective of patient’s opinion); doctor’s decision should be final in case of disagreement and interest in learning ethics (P < 0.05). However, no difference reported among them with respect to patient wishes, informing patient regarding wrongdoing, informing close relatives, seeking consent for children and patients’ consent for procedures. Furthermore, no significant difference observed between the two with respect to the practice of health-care ethics. Surprisingly, the response of clinical and nonclinical faculty did not differ as far as awareness and practice of ethics were concerned.
Conclusion: The significant difference is observed in the knowledge, awareness, and practice of ethics among consultants and SRs. Conferences, symposium, and workshops, on health-care ethics, may act as a means of sensitizing doctors and thus will help to bridge this gap and protect the well-being and confidentiality of the patients. Such an effort may bring about harmonious change in the doctor-patient relationship.
An awareness among healthcare providers of the ethics in medical care is lacking. Conferences, symposium and workshops etc. on healthcare ethics may add knowledge, awareness and practice of ethics among resident doctors at par with consultants. These efforts may ensure the protection of well-being and confidentiality of patients.
Keywords: Helsinki, ICH-GCP, medical ethics
|How to cite this article:|
Singh S, Sharma PK, Bhandari B, Kaur R. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. Indian J Pharmacol 2016;48, Suppl S1:89-93
|How to cite this URL:|
Singh S, Sharma PK, Bhandari B, Kaur R. Knowledge, awareness and practice of ethics among doctors in tertiary care hospital. Indian J Pharmacol [serial online] 2016 [cited 2020 Mar 28];48, Suppl S1:89-93. Available from: http://www.ijp-online.com/text.asp?2016/48/7/89/193320
World-War II witnessed the unethical practices era in clinical research. Humanity was shattered with the atrocities in research. This resulted in the drafting of “Declaration of Helsinki” by the World Medical Association, a guidance document for the ethical conduct of clinical research. Despite Helsinki Declaration, there were instances of unethical research and clinical practice such as Tuskegee syphilis study, thalidomide tragedy, and radiation experiments during the cold war in the US.
With the advancement of health care and medical research, doctors need to be aware of the basic ethical principles formulated to protect the well-being and confidentiality of the patients. Not respecting the patient wishes and rampant increase in the unethical practices by doctors have tarnished their image in the society. Deteriorating doctor-patient relationship and unawareness among the doctors about the ethical principles have led to increase in the lawsuits by the patients on the doctors. Measures are needed for improving awareness of ethics among health-care providers for a healthy doctor-patient relationship. The present cross-sectional study is an attempt to assess the knowledge, awareness, and practice of health-care ethics among health-care professionals (doctors) in a tertiary health-care institution.
| » Materials and Methods|| |
A cross-sectional study was conducted in Department of Pharmacology at AIIMS, Jodhpur in accordance with International Conference on Harmonisation-Good Clinical Practice and Indian Council of Medical Research guidelines after getting approval from Institute Ethics Committee. After explaining study details to the each participant and written informed consent was obtained. The participation was entirely voluntary in nature. A standard questionnaire in the paper form, was administered to the consultant doctors, senior residents (SRs) of both clinical and nonclinical departments. Failure to provide written informed consent was taken as exclusion criteria. Three participants refused to give written informed consent and were not included in the study. Responses to the questions were recorded followed by their detailed analysis. Confidentiality and anonymity of the participants were maintained as no personal information was recorded on the questionnaire. Comparative analyses were done with regard to knowledge, awareness, and practice of ethics between consultant and resident doctors and also between doctors of clinical and nonclinical specialty.
Data were expressed as mean ± standard error (SE). Responses were analyzed as nominal data. The data were analyzed using Student’s t-test for numerical and Chi-square test for categorical data. A P < 0.05 was considered statistically significant. Data analysis was done using SPSS version 21 (IBM Corp., Armonk, NY, USA).
| » Results|| |
The responses with regard to knowledge and awareness of ethics among doctors have been shown in [Figure 1]. About 70%–80% of the doctors were aware that the patient’s wishes must always be adhere to; patient should be informed of the wrongdoing to him/her and doctor’s paternalistic attitude. The importance of confidentiality was realized by 94% and 76.1% opined that close relatives should always be informed about patient’s condition. Almost two-third (66.4%) participants are of the opinion that patient’s decision should be final if there is disagreement between doctor and patient. A similar percentage (64.1%) also believed that if the patient refused treatment, he should not be instructed to find another doctor.
|Figure 1: Percentage of responders with regard to knowledge and attitude of ethics|
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Health-care ethics is important not only to avoid legal action but also undeniably an integral part of teaching syllabus, agreed by 80%–90% of the participants. Not only they agreed to above facts but also showed keenness to learn the same [Figure 2]. Analysis revealed that ethical practices are being followed by majority and is supported by following observations: 86.3% do not write blood pressure or systemic examination normal if it has not been done; 88.1% do not assist even if patient’s wishes to die; 93.2% do not want confidentiality to be breached even if it is difficult to keep and so on.
Knowledge, awareness [Table 1], and ethical practices [Table 2] were compared among consultants and SRs. SRs had significantly less awareness with regard to the importance of confidentiality; believed that doctor’s decision should be final; and their opinion should rule over patient’s opinion when compared to their more experienced consultant fellows (P = 0.034; 0.003, and 0.015, respectively). However, there was no discordance in opinion between clinical and nonclinical specialty with regard to knowledge, awareness [Table 3], and ethical practices [Table 4].
|Table 1: Difference in knowledge and awareness of ethics among consultants and senior residents of tertiary care hospital|
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|Table 2: Difference in ethical practices among consultants and senior residents of tertiary care hospital|
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|Table 3: Difference in knowledge and awareness of ethics among clinical and nonclinical faculty of tertiary care hospital|
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|Table 4: Difference in ethical practices among clinical and nonclinical faculty of tertiary care hospital|
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| » Discussion|| |
In India, legal suits on doctors have increased in recent years; this can be largely attributed to lack of knowledge and practice of medical ethics. The present study assessed the knowledge, practices, and attitudes related to health-care ethics among consultants and SRs in a tertiary health-care setup. The results of our study indicate that there is a significant difference observed in the knowledge, awareness, and practice of ethics among consultants and SRs. A small percentage (9.6%) of SRs considered confidentiality as an unimportant aspect of treatment, but the fact is that it is a fundamental tenet of medical care. In our opinion, such doctors could be the target population where the focus of teaching ethical principles should be. The physician must respect the privacy of a patient. The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his/her professional duties except (i) in a court of law under orders of the presiding judge; (ii) in circumstances where there is a serious and identified risk to a specific person and/or community; and (iii) notifiable diseases.
In response to the question “Doctor should do best for the patient irrespective of patient’s opinion,” 78.1% of residents agreed. This is what we consider is not ethical as informed consent is mandatory which ensures that one’s autonomy is respected. Although in Medical Council of India (MCI) regulations for professional conduct, etiquette, and ethics, the consent is mandated only for surgical procedures. On international platform, the principle and practice of informed consent rely on the opportunity for patients to ask questions when they are uncertain about the information they receive; to think carefully about their choices; and to be forthright with their physicians about their values, concerns, and reservations about a particular recommendation.
64.1% of doctors responded positively to “No physician shall arbitrarily refuse medical care to a patient even if patients refuse treatment due to his beliefs.” However, for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.
An important observation that could be drawn from this study was that there is undoubtedly a gap between knowledge of medical ethics among consultants and SRs. Another valuable observation is that there was no significant difference in knowledge and awareness of medical ethics among clinical and nonclinical faculty. The most plausible explanation for such observations could be: Senior doctors (consultants) have a long professional career and gained this knowledge through their real life experiences during medical practice; frequent exposure or participation as delegates, keynote speakers in workshops, continuing medical education, and conferences on medical ethics. Through this study, it is interesting to know that SRs are very keen to learn about medical ethics, a healthy and desirable observation. The dilemma is that medical ethics is a grossly neglected area and also there is no formal training imparted to medical undergraduate and postgraduate. Although animal ethics are taught to undergraduate medical students but clinical ethics is not part of the medical curriculum.
A study conducted in 2014, also exhibited gaps between the knowledge about practical aspects of health-care ethics among physicians and nurses. The author has expressed concern about the absence of medical ethics in the curriculum of undergraduate and postgraduate medical students.
In India, medical ethics are emphasized mainly in research but not in clinical practice. Although ethics committees are established at institutional levels but they mainly focus on protection of human subjects in research studies. It is important to understand that clinical ethics are different from research ethics. In research ethics, the informed consent and confidentiality of patient are documented but not in day-to-day clinical practice. MCI has formulated regulations for professional conduct, etiquette, and ethics which is available on their website (http://www.mciindia.org/RulesandRegulations/CodeofMedicalEthicsRegulations2002.aspx) but most medical professionals either are not aware of it, or they do not access it.
| » Conclusion|| |
Around three-fourth of doctors have adequate knowledge and awareness of ethics and have also been practicing it in their day-to-day clinical practice. Despite these healthy figures, a large pool of health-care providers is to be taught and made aware of ethics in medical care. To bring knowledge, awareness, and practice of ethics among residents at par with consultants, interventions such as conferences, symposium, and workshops on health-care ethics may be warranted. These efforts may act as a means of sensitizing doctors; help to bridge the gap in knowledge, awareness, and practice of ethics and ensuring the protection of the well-being and confidentiality of the patients.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]