Have you met an educated man lately?
As an educated man – and I confidently state that I am – choosing among the many options that present themselves in daily life should be easy. Wrong! The more I know, the more choices I have to consider, and the more effort I have to exert to reach a good decision. Not included in the equation are those factors that color my decision-making process, e.g., the perks that I enjoy but might lose, the relationships developed in the course of my so-called ‘continuing education’, the biases that have evolved over time, and the entitlement that I think I deserve for having invested on what has made me what I am – an educated man. The choices I make may not always be the best, but I doubt that they can ever be that bad!
What if I were an uneducated man, what choices do I have, and which ones can I make? Is it not likely that my lack of education would be attributable to my family’s financial incapacity? If I were not educated, can I make the best choice, and if yes, can I afford it? What would be the best choice then, the one that the learned world endorses to be the best, or the best that I can afford? If I neither have the education nor the funds, what chances are there that I can even make a choice? And is it safe to leave me alone to make a choice given the circumstances of my ignorance and poverty?
One logical solution would be to let the educated man decide for the uneducated and, by association, the poor. Doesn’t it make sense and isn’t it more practical to decide for them rather than to go through great lengths and expense trying to educate them, without any assurance of success? Aha, but isn’t this exactly what has been happening? How regularly do we see this in the name of law and order, in the name of religion, in the belief that what is ‘good for us’ is what is good for everyone? What happens then, when the educated man succumbs to the nobility of his existence as he tests the limits of his influence and acquires the arrogance of his position? (Or is it the other way around – when arrogance lead people to seamlessly acquire the trappings of the educated man?). Being poor becomes equated with being uneducated, and being silent with being powerless. The choices of the educated levitate to the sophistication of world-class standards; the choices of the poor and powerless sink to the banal issue of cost.
So, should the educated man decide for the poor?
Well, as it turns out, the poor is not exactly helpless. Our poor patients stop taking the medicines we prescribe if and when they can no longer pay the price. Under such unfortunate circumstance, a decision is still made! From there, they can decide to stop seeing us altogether when our medical expertise translates into nothing that they can ever hope to benefit from because it is simply beyond their reach! It is their decision – and that decision is simply to drop us from their list of choices! No amount of educated posturing from our end can make them buy what they cannot pay for, or pay for what they cannot sustain. So what difference does it make that we have an arsenal of knowledge that they have little use for?
But certainly, the educated man can do much more! We, doctors, for example, can make it so much easier for our patients to decide by making ourselves a viable choice. Well, the funny thing is that the educated man may not even be able to decide for himself! Just like the wheel of misfortune, the doctor may find himself in the same situation as his patients. For the sake of discussion, if his patients are not knowledgeable enough and, thus, must be protected from the so-called evils of the Reproductive Health Law, neither is his profession noble enough to exercise propriety in prescribing medicines. For a period of time, his silence on issues that affect health care had lumped him together with the uneducated, giving the politicians latitude and a false sense of superiority. He had a serious panic attack when the Cheaper Medicines Bill threatened to penalize him for writing his chosen brands in his prescriptions. As a recourse, he sought refuge in the retention of the provision of the 1987 Generics Law that allows him to write his chosen brands in parentheses alongside the generic names of the drugs he prescribes.
But when the Generics Law was about to be passed many years before that, which required him to include the generic names of the medicines in his prescriptions, he raised hell (Boy, did he raise hell!). Because including the generic names of his chosen brands would do what? That it would make his patients aware that there were other brands to choose from! What an irony! We cringe at the thought of being penalized for making our choice, but how easily we take for granted our patients’ right to make theirs. The paradox of the educated being intolerant of education.
Where does the problem lie? Where it lies is where the solution is. Times are changing; our education no longer grants us the power of indispensability. The decisions we make cannot be ours alone; our patients have as much say as we do. After all, they undergo the diagnosis and treatment, suffer the pain and inconvenience, and at the end, pay for everything, sometimes with their lives! Choices have to be made based on mutual respect, the best being what science can provide and what the patients are ready for and most comfortable with. We cannot decide for them; we decide with them.
Medical practice, indeed the medical profession itself, has changed drastically. From a deified stature of power and respectability, it is now fair game to the mathematical prowess of the tax collector. – no different from any other business enterprise. Throw in the increasing leverage of 3rd party payors and suppliers; the disruptive innovations in science and technology; the proliferation of substandard and fake drugs; doctors claiming to be what they are not, doing what they are not credentialed to do; medical associations in disarray, run by doctors who cannot lead; the assault of politicians and media on our profession – what we have is a profession on a tight-rope. Let it be resolved, therefore, that our relationship with our patients should no longer be an encounter between the educated and the helpless, but a partnership that enlightens and strengthens both parties against all these things that undermine it.
The educated man chooses to listen, share, and accommodate rather than call attention to the brilliance of his education. He chooses to sit beside himself rather than on his laurels, because in these times of counterfeits and questionable integrity, laurels are but ornaments that elicit neither attention nor awe and are soon forgotten.
Have you met an educated man lately?
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