By Ramadan Misbah
At over seventy years of age, blessed with good health, I approached a recent minor medical concern with philosophical acceptance. Yet, the experience became a profound case study in the shifting ethics of modern medicine.
I chose to visit the daughter of my long-time, trusted physician—a man of the old school whose care was always defined by patience, thoroughness, and a human touch that preceded any discussion of payment. My intent was dual: to address a health matter, and to conduct a generational audit. Where are our new medical graduates, products of Morocco’s evolving system, leading us? Have they enriched the noble practice, or diminished it?
The divergence from tradition was immediate and jarring. The first gatekeeper was not clinical concern, but a financial one: payment was demanded upfront, before any examination, diagnosis, or even a customary greeting. This transactional pre-condition stands in stark contrast to the foundational oaths that have guided healers for millennia. The Hippocratic Oath emphasizes service above gain, while the oath from the First World Conference on Islamic Medicine eloquently commands the physician to be “an instrument of God’s mercy; extending my medical care to the near and far, the righteous and the wicked, the friend and the foe.” Demanding payment first subtly reorders these priorities, placing the mercantile before the merciful.
Payment Before Service:
The consultation that followed was a masterpiece of disengaged efficiency. Lasting mere minutes, it felt less like an examination and more like a hurried checklist. My attempts to provide context—a crucial part of any diagnostic process—were brushed aside. When I dared to suggest a possible anatomical connection between symptoms in my neck and ears, I was dismissively told that was “a matter for writers, not doctors.” This reflects a dangerous reductionism, ignoring the holistic understanding that the patient’s narrative is the first and most important diagnostic tool.
The Referral Web: A Modern Ethical Quandary
Then came the directive for an ultrasound—at a specific laboratory she named, citing her personal trust in it. While I happened to use that lab, her insistence illuminated a common ethical gray area in private practice: the kickback or referral fee. This practice, where a doctor receives compensation for steering patients to a particular facility, creates a conflict of interest that can undermine diagnostic objectivity and inflate costs. It transforms a medical recommendation into a potential commercial transaction.
Good Morning, Doctor:
When I later questioned the prepayment policy, contrasting it with her father’s approach, her justification was revealing: “He is a man and I am a woman… Should we call the police every time?” This rationale is troubling on multiple levels. First, it prioritizes a perceived physical deterrent (manhood) over the rule of law and professional contract—a surprising stance for a university-educated professional. Second, it allows the fear of a rare, non-paying patient (a statistically marginal risk, especially in a monitored clinic) to dictate the treatment of the overwhelming majority of honest patients, fundamentally altering the covenant of trust before the interaction even begins.
The subsequent ultrasound experience served as a powerful counterpoint. The radiologist’s demeanor was the embodiment of competent, compassionate care: deliberate, explanatory, and reassuring. Her final pronouncement, “Oh Hajj: Praise be to God, it’s fine,” carried a warmth that was both medically sound and spiritually comforting. This was medicine as it should be—a fusion of science and humanity.
A Doctor of Another Caliber:
My return to the prescribing doctor with the results completed the disillusionment. She offered only a fleeting glance at the detailed report concerning my own body, provided no explanation, and immediately moved to prescribe further tests. This failure to communicate, to guide, and to empathize represents a critical breakdown in the physician’s role. The patient is left adrift, forced to turn to “Google” for understanding, while the doctor functions merely as a referral engine. I concluded the consultation myself, stating the file was closed.
This experience crystallizes a central, corrosive tension in modern healthcare. The business of medicine and the art of healing are increasingly on divergent paths. The demand for prepayment is more than a administrative policy; it is a symbolic act that establishes a commercial relationship before a healing one. It says, “You are a customer first, a patient second.”
A Silent Echography:
The solution must be systemic. Medical education requires a fortified, non-negotiable core curriculum in Professional Honor and Medical Ethics, moving beyond abstract oaths to practical training in patient communication, ethical business practices, and managing the pressures of a privatized system. Professional medical associations and regulatory bodies should also scrutinize policies like mandatory prepayment and opaque referral networks, which can erode public trust.
The author’s concluding metaphor is tragically accurate: Greed and competent, compassionate medicine are two parallel lines. They may run side-by-side in the modern healthcare landscape, but they must never, and can never, truly meet without one corrupting the other. The soul of the profession depends on ensuring the line defined by mercy remains the one we follow.
This critique is not an indictment of all new practitioners, but a call for vigilance. It champions the timeless model embodied by the old doctor and the radiologist: where expertise is delivered with patience, explanation, and an unwavering commitment to the patient’s holistic well-being—a model that earns not just a fee, but enduring respect and trust.