WHAT EVERY SURGEON'S ETHICS SHOULD BE?

Ethics is defined as moral principles that govern a person's behavior, the conductivity of an activity, or the branch of knowledge that deals with honest attitude.

 Ethics is a branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct.

 Ethics was found in Hammurabi code law (Babylon 1754 B.C.), then followed by    Hippocratic Oath, prayer of Moses maimonides, declaration of Helsinki, code of ethics of the American Medical Association, and all Holy Books which insist on ethical points.

 Ethics in general is governed by four principles which are; respect for autonomy, beneficence, non maleficence, and justice. To the above, I added; respect for the dignity of the patient.

 Ethics start from humanitarian handling of the patient in the first visit with a big smile and soft welcoming words, a lot of respect, careful listening and understanding followed by very gentle physical examination.

 If investigations or imaging are required, they should be addressed to the specified places far away from personal exchange benefits, and should be absolutely indicated, keeping in mind, the patient's financial status away from laboratory or hospital gain.

 Think always how to alleviate the patient suffering rather than how much to get from him, because the patient's benefit should come on the top of everything.

 After achieving the definitive diagnosis, every thing must be clarified to the patient in a gentle way, particularly if serious condition is discovered. The informed consent which is a part of the ethical conduct must contain all details, including the complications and prognosis. A gentle communication skill is required to deliver the bad news.

 The treatment is to be tailored solely for the patient specific conditions, far away from hospitals or companies advantage. Prescribing narcotics should be better to the least possible to reduce the risks of addiction.

 Justice is required in treating all patients equally even if they are war prisoners. No differentiation according to race, religion, gender, color discrimination and believe.

 Negligence is a surgical crime. Second opinion is considered mandatory when required, and it is much better than offering wrong medical service.

 Running between hospitals makes surgeons mentally busy and will be reflected badly on their offered service. Because of this situation, some surgeons leaves the follow-up to junior staff which is reflected badly on the patients morals, moreover some pathology may be missed by junior staff. Sadly, some surgeons insist on using certain implants or medicine irrespective of the price with the intention of exchange benefit which is ethically rejected.

 What is worse is performing unnecessary surgery to make the surgeon's pocket heavier, or for the benefit of the private hospitals.

 Another point of weakness is to make operative decision depending on the results of investigations or imaging and forgetting the false positive results.

 On the other hand, no surgery is done because the patient can not offer the money required. This policy should be resisted, and the surgeon duty is to find a venue to help poor patients.

 Globally, there is over utilization of surgery for many reasons, probably on the top of this is financial gain for the surgeons. Failure of conservative treatment is not always a good indication for surgery.

 The outcome of recent advances, better to be considered cautiously till it take plenty of time so we have to wait for the foam to settle down.

 The juniors have the right to learn and improve their technical skills, but this should be done under strict supervision.

 There is an ethical rule that governs the funding for clinical trials from the market companies so that bias can be avoided.

 Also there are rules and rights for protecting the patients and even experimental animal in performing researches.

 It is a good idea to ask the patient to appoint a proxy, to give permission for procedures that not agreed upon prior to surgery but discovered to be necessary at time of surgery.

 Unfortunately, some surgeons try to push the patient away when bad outcome or complications developed. I feel the contrary; surgeon should help his patients and find a solution in this desperate situation.

 Finally, we look for a surgeon who is frank, honest, faraway from the financial gain, respectful by his patients; never give a false sense of hope, with a sound skill, good judgment and full of ethics.