প্রবাসী ACCOUNTABILITY IN MEDICINE Introduction, Accountability is the concept wherein someone can be held responsible for his action. The individual concerned is expected to give answer to what he has done. Blameworthiness, liability ,answerability are often considered synonymous to it. It is associates with ethics and good Governances. It is an account giving relationship between individuals where one informs and explain to the other what is was or will be his actions and decisions and eventually punishable for wrong doings. When applied to public sector the employees have to report, explain and answer to their chiefs who in turn are answerable to the Government and the Government is “for the people of the people and by the people”. So in Democracy the accountability of the public sector is ultimately to the people. When applied to the practice of Medicine accountability is a question of both Governance and ethics. The Practice of Medicine The practice of Medicine involves the care givers, the patients or the people and ethics. Now let us delve deeper into each aspect of the parties involved. The care givers are the physicians and allied health professionals, the institution and its administration. When it comes to self employment for the physician the question of ethics plays the dominant role as there is no administration. The physicians Medical profession is the single most important noble profession. One of the Basic needs of human being is health along with food , shelter, clothing, education etc. Unlike many other occupation medical care may be the fundamental question to survival. Once health is assured better quality of life comes to the question. In many countries specially in the social welfare ones the Government has assured health care to all its citizen. Here lies the accountability of the Government to its people. The physicians play the crucial role for health care. He is the man who knows what’s wrong with the individual and what action is necessary. Every physician is committed to the “Hippocratic Oath” a code of conduct for the doctors laid down centuries ago in the ancient Greece. And therefore it can be well assumed that every doctor knows his/her responsibilities and duties. The “Hippocratic Oath” begins with “on being admitted as a member of the Medical profession I solemnly pledge to consecrate my life to the service of humanity”. Further the oath says ”The life of my patient will be my first consideration”. So it can be well assumed that every physician knows his duties clearly. Through his education and knowledge he is expected to be clear about his responsibilities and duties. The physician practice in Medicine can be Institutional, both in public and private sectors or he may be self employed. Medical institutes again can be Academic and non academic ones. In the academic institutes the responsibility of the professional includes academic activities like teaching, Research , organizing Seminar and symposia in addition to the usual treatment and care of the patients. Thus in academic institutes be it Undergraduate or post graduate this extra responsibility is bestowed upon the profession. Medical Practice in the private setting includes private hospitals, nursing homes, clinics and private practice offices. Both professionals and non professionals run these institutes. Off course it is true that accountability is more in the private setting than in the public sector. And it is also true that quality of Medical care is better in the private sector where it is generally more expensive. Money brings responsibility and accountability and accountability improves quality of service. In the public sector where Medical care is mostly free of cost and the level of care is often inadequate. This is because governance ,transparency accountability is often minimum . Governance is poor because of corruption and nepotism and transparency is lacking. The right to information is lacking because of bureaucratic tangles and other hurdles. As in other public sector people have little access to information though ideally they should have. People are often denied access to information even if they wish to know why the medical care went wrong. The Allied Health professionals and staff:- T he practice of Medicine is now- a-days more diversified than before as a consequence other non physician people are involved in it. They are essential part in the practice of Medicine and includes nurses, technicians, social workers ,administration and infra structures. In the corporate sector these non physician staff are also essential part of Medical practice. The whole practice is a team work where every individual plays his/her role. Every individual has his or her responsibility and therefore accountability. Why accountability in Medicine is important? The practice of Medicine is directly involved with life and health of an individual. Where as one can go without service of many other occupations there is hardly any who can go without medical care. Patients pay dearly in terms of money, health and even life for the mistakes committed by the health professionals. To whom should the practice be accountable? Like other services it is to the people to whom the practice should be accountable because in a democracy the government is by the people. Of course there are loopholes in the democracy in our country. Democracy has often been interrupted . The politicians in the government as well as in the opposition often fail to play their roles . The Administration concerned with the Health and therefore with practice of medicine are many a times inappropriate. Conclusion:- Accountability improves quality of service. The question of accountability is more vital in the practice of Medicine than many other services. Good governance ensures transparency . Transparency and accountability improves quality of service. In the practice of medicine accountability is for the benefit of the patients and therefore for the people in general. Prof.(Dr.)Birendra Nath Bhattacharjee MBBS, FCPS MS. Retired Professor of Physical Medicine