IN The Doctor’s Dilemma: Preface on Doctors, George Bernard Shaw wrote: “On the other hand, when the doctor is in the dock, or is the defendant in an action for malpractice, he has to struggle against the inevitable result of his former pretence to infinite knowledge and unerring skill. He has taught the jury and the judge, and even his own counsel, to believe that every doctor can, with a glance at the tongue, a touch on the pulse, and a reading of the clinical thermometer, diagnose with absolute certainty a patient’s complaint, also that on dissecting a dead body he can infallibly put his finger on the cause of death, and, in cases where poisoning is suspected, the nature of the poison used.

“Now all this supposed exactness and infallibility is imaginary; and to treat a doctor as if his mistakes were necessarily malicious or corrupt malpractices (an inevitable deduction from the postulate that the doctor, being omniscient, cannot make mistakes) is as unjust as to blame the nearest apothecary for not being prepared to supply you with sixpenny-worth of the elixir of life, or the nearest motor garage for not having perpetual motion on sale in gallon tins.”

Penned in 1906, Shaw’s words still hold true today. They are an indictment of the current state of medical practice in that we live in a time where doctors are expected to be both perfect and altruistic beyond our means.

The paradox brought about by advancing technology is that both said technology and doctors are often seen as infallible – and yet, when clinical situations sometimes irrevocably deteriorate, more often than not the slide towards death and morbidity stems not from a lack of trying or application of the latest methods, but because our being mortal means that there are certain inevitabilities.

With this established perception of doctors in the mind of the general public, the advent of social media has opened a Pandora’s box of horrors for the medical fraternity in Malaysia. We are daily inundated with viral stories of unfounded medical negligence (the more shocking, the better) which tabloid portals and various websites are only too happy to run as click-bait or to fish for likes.

The current case being discussed in medical groups all over the country regards 11-month-old Joel Neo who was admitted to a private hospital in Johor in late April 2017 with spiking fever.

According to accounts from her father’s social media posts, she deteriorated rapidly overnight, becoming comatose at which point she was intubated and transferred to Hospital Sultanah Norah Ismail, where she was diagnosed with acute necrotising encephalopathy of children (ANEC), a disorder so rare in this part of the world that many seasoned paediatricians and radiologists had hardly seen or heard of a case, much less managed one.

With ANEC, mortality rates climb as high as 70%, and in children who survive, permanent neurological disability is common. Tragically, according to information gleaned on social media, little Joel succumbed to her illness after 11 days in the intensive care unit.

Speaking on behalf of the medical fraternity in Malaysia, I am sure that we are collectively broken by little Joel’s passing. We extend our sincerest condolences to her parents and family, and we would like to say that we are so very sorry for the loss of your baby girl, which is something that no parent should ever have to go through.

Her grieving father took to social media to express his disappointment with the care received at the hospital where Joel was initially warded.

While this was completely understandable given his grief, the majority of responses that followed from an incensed public were vitriolic and plainly unacceptable.

In the online court of public opinion, both my colleague managing the case and the hospital had their reputations and names dragged through the mud without being allowed the decency of a proper inquiry following the rule of law and established procedure. Their names, house addresses and car number plates were published online for all and sundry to view.

Netizens with absolutely no medical training were quick to establish that medical negligence had occurred and had no qualms goading the grieving parents to hire lawyers to punish the perpetrators.

One politician even announced on her Facebook wall that she was considering helping the parents explore the possibility of launching medicolegal action.

While allowing for the maelstrom of emotions swirling through a situation like this, there are questions I would like to ask the public:

Since when have we been not allowed to fail?

How have we gotten to a point where we, as a medical fraternity, have been expected to be altruistic beyond reasonable expectations?

How did we get to the point where we are in danger of being unnecessarily crucified for honest mistakes or unavoidable outcomes without a chance to defend ourselves?

When did it become acceptable to defame someone without availing yourself of all the facts? (Netizens should be aware that the Defamation Act 1957 opens them up to litigation as well.)

When the public begins to place the spectre of looming litigation on our shoulders, do not complain when the cost of medical care goes up due to increasing indemnity insurance costs.

Do not complain when we fob you off to other hospitals and refuse to manage potentially catastrophic cases because of the threat of having our characters assassinated unfairly.

When things go wrong in medicine (and they often do), please let those involved grieve in private. Do not rob them of the catharsis that the grieving process brings by unnecessary goading.

Do not take matters into your own hands by vilifying and demonising people and institutions who may very well be absolved of wrongdoing should the case go to court.

Lastly, let us, as a professional fraternity, examine ourselves and our methods for weaknesses and mistakes.

Help us to help ourselves. And if it should come to litigation, by all means let the process of law take its due course without resorting to unfair character assassination of fallible human beings who may be trying to be the best doctors they can be.

DR JULIAN TAGAL

Ophthalmologist

Sarawak General Hospital