2-6.
VARYING ETHICAL VALUES AFFECT THE PRACTICE OF MEDICINE IN
DIFFERENT LOCALES
a. Culturally Based Health Care. In the first lesson, a distinction was made
between the technical aspects of your job for which there is a right and a wrong way of
doing things, and the art of providing health care for which the answers are less clear-
cut. But even this distinction is not so hard and fast. Seemingly objective technical care
and treatment decisions are also affected by the prevailing cultural biases (values).
Lynn Payer, an American who spent 8 years as a medical journalist in Europe, outlines
these differences: "...the way doctors deal with patients and their ailments is largely
determined by attitudes acquired from their national heritage (emphasis added). The
practice of medicine, finally, is an art. And like painting and sculpture, it reflects the
culture from which it comes."16
b. Medicine in the United States. American medicine is imbued with the
aggressive, "can do" attitude of the frontier. American physicians order more diagnostic
tests than most of their counterparts in Europe, prescribe drugs frequently and in
relatively high doses, and seem to resort to surgery whenever possible.
(1) American women are much more likely to deliver their infants by
Caesarean section, and undergo routine hysterectomies and radical mastectomies
while still in their 40's. The body is viewed as a machine by both patient and physician.
Thus like a car, it needs annual checkups and devices like the artificial heart. We
perceive death and disease as the enemy to be "conquered."
(2) Antibiotics are frequently prescribed in large doses, for even minor
infections. Patients are expected to be aggressive. Patients who submit to drastic
treatments in order to "beat" cancer are more highly regarded than patients who resign
themselves to the disease.17
c. Medicine In Great Britain. British medicine is low-key by comparison.
English physicians don't believe in routine physical exams, rarely prescribe drugs, and
order only half as many x-rays as their American counterparts. The British patient is
only one-sixth as likely to have coronary-bypass surgery and will probably never have a
CAT (computerized axial tomography) scan. This economy of practice is due, in part, to
the fact that medicine is socialized (funded by the National Health Service). British
physicians have always been conservative. Contrary to the American tendency to do
everything possible, British medical practice reflects the philosophy, "when in doubt,
don't treat." The British attitude of maintaining a "stiff upper lip" is also reflected in
medical attitudes. Psychiatrists, for example, tend to regard people that are quiet and
withdrawn as normal, while quickly prescribing tranquilizers to anyone who seems
unsuitably overactive.
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