COVID-19大流行:医学专业主义的视角

H. Sra, Meenu Singh, K. Talwar
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Going by the numbers given by the Indian Medical Association, more than 500 doctors have lost their lives to this deadly virus in the secondwave andmore than700during the first wave.1 Many doctors and other health professionals have faced mental stress and fear of passing on the disease to familymemberswhile goingback homefromduties.However, this was a testing time for all of us as wewere fighting against an unknown enemywhile doing the sacred duty in the service of society. Doctors and nurses are frontline warriors in this struggle; hence, some casualtieswere expected. Our physician friendswho lost their lives in this strugglewill be remembered for their sacrifices. This pandemic has taught us many lessons and exposed the weakness of our health system. We not only need adequate infrastructure but also competent professionals. The quality of training and development of specialities is the need of the time. We have very few critical care specialists and infectious disease specialists in the country. Similarly, the number of trained nurses in the ICU care is limited. The medical profession needs serious reforms. The long duration and lack of opportunities for professional growth has seriously affected the attraction to join this profession. Presently, it is no longer the preferred career attraction amongst the bright students. The society cannot afford to have their health care needs in the hands of mediocre students. This pandemic has taught that health profession needs dedicated bright brains with excellent training to handle serious health issues. The importance of having public health specialists to handle such health crisis has been amply realized. Hope, the new NMC addresses these issues to ensure quality training, development of new desired medical disciplines and ensure adequate opportunities. Another lessonwe learnt during this pandemic is having adequate resources for providing adequate infrastructure and facilities to health professionals. Problems concerning the (re)allocation of scant medical services are pervasive, with healthcare professionals not only fighting to combat the virus, but also limiting accessibility and the grade of treatment for several other patients, presenting underlying ethical considerations of equality and equity.2 Guidance control (capacity to complete a planned activity) and regulatory discretion (capacity to select amongst options) are required to be both professionally liable and ethically right.2 Medical professionalism in clinical settings requires communication involving physicians and patients, and this should be a relationship founded on empathy, honesty, and accountability, which has proven to be challenging in this pandemic scenario. Trust is a prerequisite for a positive physician–patient relationship. 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引用次数: 0

摘要

COVID-19扰乱了数百万人的生活,一线医护人员在这场大流行中首当其冲。第二波COVID-19大流行严重削弱了印度。它让整个国家措手不及,每天的人数和死亡人数飙升至历史新高。在这种危险的困境中,医生和护士尽了最大的努力,为受这种疾病影响的人提供最好的治疗。在没有任何有效药物和病毒高度传染性行为的情况下,许多医护人员被感染,甚至失去了宝贵的生命。根据印度医学协会提供的数据,第二波有500多名医生死于这种致命病毒,第一波有700多名医生死于这种病毒许多医生和其他卫生专业人员都面临着精神压力,担心下班回家后会把疾病传染给家人。然而,这对我们所有人来说都是一个考验的时刻,因为我们在为社会服务的神圣职责中与未知的敌人作斗争。医生和护士是这场斗争的前线战士;因此,预计会有一些伤亡。我们在这场斗争中牺牲的医生朋友将因他们的牺牲而被铭记。这次大流行给我们带来了许多教训,暴露了我们卫生系统的弱点。我们不仅需要足够的基础设施,而且需要有能力的专业人员。提高专业人才培养和发展的质量是时代的需要。我们国家的重症监护专家和传染病专家非常少。同样,重症监护病房中受过训练的护士数量有限。医疗行业需要严肃的改革。持续时间长,缺乏专业成长机会,严重影响了人们加入这一行业的吸引力。目前,它不再是聪明的学生首选的职业吸引力。社会不能让普通学生来满足他们的医疗需求。这次大流行告诉我们,卫生专业需要受过良好培训的专业人才来处理严重的卫生问题。拥有公共卫生专家来处理这种健康危机的重要性已得到充分认识。希望新的NMC能够解决这些问题,以确保高质量的培训,发展新的理想的医学学科,并确保充分的机会。我们在这次大流行期间吸取的另一个教训是,有足够的资源为卫生专业人员提供适当的基础设施和设施。关于(重新)分配稀少的医疗服务的问题普遍存在,保健专业人员不仅要与病毒作斗争,而且还限制了其他几名患者的可及性和治疗等级,提出了平等和公平的基本伦理考虑指导控制(完成计划活动的能力)和监管自由裁量权(在选项中进行选择的能力)需要具有专业责任和道德权利临床环境中的医疗专业精神需要医生和患者之间的沟通,这应该是一种建立在同情、诚实和问责基础上的关系,在这种大流行的情况下,这已被证明是具有挑战性的。信任是积极医患关系的先决条件。病人应该相信他们的临床医生所做的决定符合他们的最佳利益然而,为了持续地照顾他人,卫生保健工作者应首先照顾自己,这需要使用足够的个人防护装备(PPE)并遵守感染控制政策,即使这推迟或减少了与急诊室患者的接触。如果我们为共同的目标团结一致,我们将依靠我们的医疗专业精神战胜这一世代的挑战。医生有职业义务按照医疗专业精神的核心原则行事,包括优先照顾病人、病人自主和社会
本文章由计算机程序翻译,如有差异,请以英文原文为准。
COVID-19 Pandemic: Perspective on Medical Professionalism
COVID-19 has disrupted the life of millions with frontline healthcare workers being at the greatest brunt of this pandemic. The second wave of the COVID-19 pandemic has crippled India enormously. It caught the entire country unprepared with daily numbers and deaths soaring record high. In this perilous predicament, doctors and nurses have tried their hardest to deliver the best possible treatment to those affected with the disease. In the absence of any effective medication and a highly infectious behavior of the virus, many healthworkers got infected and even lost their precious lives. Going by the numbers given by the Indian Medical Association, more than 500 doctors have lost their lives to this deadly virus in the secondwave andmore than700during the first wave.1 Many doctors and other health professionals have faced mental stress and fear of passing on the disease to familymemberswhile goingback homefromduties.However, this was a testing time for all of us as wewere fighting against an unknown enemywhile doing the sacred duty in the service of society. Doctors and nurses are frontline warriors in this struggle; hence, some casualtieswere expected. Our physician friendswho lost their lives in this strugglewill be remembered for their sacrifices. This pandemic has taught us many lessons and exposed the weakness of our health system. We not only need adequate infrastructure but also competent professionals. The quality of training and development of specialities is the need of the time. We have very few critical care specialists and infectious disease specialists in the country. Similarly, the number of trained nurses in the ICU care is limited. The medical profession needs serious reforms. The long duration and lack of opportunities for professional growth has seriously affected the attraction to join this profession. Presently, it is no longer the preferred career attraction amongst the bright students. The society cannot afford to have their health care needs in the hands of mediocre students. This pandemic has taught that health profession needs dedicated bright brains with excellent training to handle serious health issues. The importance of having public health specialists to handle such health crisis has been amply realized. Hope, the new NMC addresses these issues to ensure quality training, development of new desired medical disciplines and ensure adequate opportunities. Another lessonwe learnt during this pandemic is having adequate resources for providing adequate infrastructure and facilities to health professionals. Problems concerning the (re)allocation of scant medical services are pervasive, with healthcare professionals not only fighting to combat the virus, but also limiting accessibility and the grade of treatment for several other patients, presenting underlying ethical considerations of equality and equity.2 Guidance control (capacity to complete a planned activity) and regulatory discretion (capacity to select amongst options) are required to be both professionally liable and ethically right.2 Medical professionalism in clinical settings requires communication involving physicians and patients, and this should be a relationship founded on empathy, honesty, and accountability, which has proven to be challenging in this pandemic scenario. Trust is a prerequisite for a positive physician–patient relationship. The patient should have faith in their clinicians that the decision made by them serves their optimal interest.3 However, to care for others in a sustained manner, health care worker should first care for themselves, which necessitates the use of adequate personal protective equipment (PPE) along with adherence to infection-control policies, even if this defers or decreases contact with patients in the ER. We shall triumph over this generational challenge counting on our medical professionalism if we work united with a shared goal. Physicians have a professional obligation to operate in accordance with the core doctrines of medical professionalism, which include prioritizing patient care, patient autonomy, and social
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