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Saturday, October 13th 2012

The Criminalization of Medicine

There is a seemingly despicable criminal case pending in the United Arab Emirates against an aged South African pediatric hemeatologist/oncologist. Dr. Cyril Karabus was convicted in abstentia for the care he provided to a UAE child with acute, probably, lymphoblastic leukemia. He had no knowledge of the 10 year old conviction until he was detained at the airport while traveling through the UAE. Despite the fact the family who originally brought the complaint cannot be found and the original police files on the investigation are lost he remained jailed for more than 2 months until his bail yesterday.

The case has drawn criticism from an editorial in the British Medical Journal, amongst other international showings of support.

I’m concerned with the criminilization of medicine. To be fair we don’t know the specifics of the case; perhaps its etiology has nothing to do with what I’m going to opine but it provides a transition to discuss an opinion passionate to me. I think the source of this trend in criminal prosecutions for medical practice is similiar to that behind the rise of the total of civil awards for medical malpractice in the United States. Such is one thing to complain about but criminal prosecutions for similar is something to be truly alarmed about.

There is strong evidence that criminal charges against physicians for medical practices have increased around the world in recent. As republished on Kevin MD the blogger Whitecoat MD had this to say about criminal charges following perceived medical malpractice,

Take their licenses away. File civil actions against them. Jail time shouldn’t be part of the paradigm.

The further we travel down the road of criminalizing medicine, the more difficult it will become to draw a line between what is and is not considered “criminal” behavior … and the fewer physicians that will want to practice medicine.

It is a sentiment I could not agree with more with.

Perceptions of poor physician performance after poor outcomes are related to patient and family expectations of their health care. This view has consequences including an increased risk of malpractice claim, and perhaps by extrapolation criminal charges, for physicians. Other research shows that around the world, including in the middle east where Dr. Karabus’ drama is playing out, expectations of medical care are on the rise. I’m of the opinion that this is part of the rise of litigiousness against physicians and the increasing use of criminal prosecutions against physicians.

Plenty of drivers of expectations fall outside the direct control of physicians. Representations of medical professionals in the media, including dramatic representations, have played a key role. So has direct to consumer marketing of pharmacuticals and medical technologies. Physicians are faced with a considerable task in managing such expectations but have failed to rise to it.

In fact, in part physicians have played into these expectations. These expectations, and the image that physicians can live up to such, are associated with increased occupational prestige and, perhaps more importantly, increased health care utilization. Such utilization plays into the increasing procedure oriented nature of health care, especially in the United States, and the growth in physician income associated with such. I’m sure every one of my colleagues reading this can claim themselves innocent of such and cite their extensive time counseling patients during consents for treatment or their refusing unnecessary requested treatments to patients; examples, I suppose, of managing expectations. It seems much like how it is always someone else doing the equivocal spine surgery.

The criminalization of medical practice is a very bad thing, particularly so in the case of Cyril Karabus with the flaunting of due process in the case. Physicians need to do more in mitigating expectations and bringing such in line with reality, to help reverse the trend.