"Health for all by the year 2000". Educational, empirical and ethical responsibilities for the medical profession.

Abstract

Health for All by the Year 2000 requires action by many different groups in the community and the medical profession is 1 group which should adopt this goal most readily. Discussion focuses on 3 major responsibilities which should be carried by the medical profession: critical reexamination of the goals and methods of medical education; the provision of empirical data i.e. data derived from careful observation for use in making decisions about medical care and the allocation of health care resources; and the development of new procedures or institutions whereby ethical dilemmas in medicine are resolved. By giving critical thought to the methods and goals of medical practice an appropriate medical education approach can be developed to train doctors for the 21st century. The essential components of this approach include: attention to the definition of goals; the choice of educational methods on the basis of evidence of their effectiveness; and the evaluation of the total educational process so that its strengths can be determined and built on and its weaknesses detected and fixed. If the medical profession of the future is to contribute substantially to compehensive programs of primary health care curricula must change. Such change calls for alteration in the system of rewards and other academic structures and management. These alterations in turn may necessitate a complete revision of current concepts of academic accountability. Another responsibility of the medical profession and particularly medical academics is the provision of sound information on which rational judgments as to where resources for health care should be spent can be based. In some countries efforts are being made to ameliorate the lack of information on which to base decisions about health care. For example the World Bank recently approved a loan of US$35 million to the Peoples Republic of China to strengthen medical education in its top 13 medical colleges. 5% of this loan has been designated to the development of education in design measurement and evaluation within the undergraduate medical program of those colleges. A 3rd responsibility for the profession is to help the community make balanced ethical choices about health care at a personal and a community level. Currently the ethical aspects of health care seem to be struggling to survive. Needed is a mechanism whereby ethical dilemmas can be discussed and resolved. Society requires a process which enables the fair resolution of competing value positions in any particular case. Doctors may need more education in the ethical aspects of their profession.