54 per cent never accepted gifts from pharmaceutical companies; however, 37.7 per cent admitted to accepting such gifts “sometimes,” and 8 per cent did so “often”.

A recently published cross-sectional study conducted across three teaching hospitals in the Kandy district of Sri Lanka reveals troubling gaps in doctors’ understanding and application of medical ethics, despite an overwhelming willingness to learn.

The research surveyed 313 doctors using anonymous, self-administered questionnaires. Results are stark: 81.2 per cent of participants scored below the acceptable threshold for knowledge of medical ethics – defined as less than 60 out of 100 – for routine clinical ethical guidelines.

Key Findings at a Glance

• Knowledge: The average score was 49.8 (±13.6), with postgraduate trainees significantly outperforming others – 60.7 per cent achieved “good” knowledge, compared to 44.4% among their non-trainee peers (p = 0.02).
• Institutional Variations: Knowledge levels also differed significantly among the three hospitals (p = 0.008), suggesting disparities in training or institutional culture.
• Attitude: A resounding 95 per cent of doctors expressed that in-service training on medical ethics is essential, and 91 per cent believed undergraduate medical ethics education is currently inadequate.
• Self-Reported Practice:
  • 69.3 per cent thought current levels of ethical practice among doctors are unsatisfactory.
  • Only 33.9 per cent always used a chaperone during patient examinations; 3.5 per cent never did – concerns surface around potential misconduct or patient discomfort.
  • 54 per cent never accepted gifts from pharmaceutical companies; however, 37.7 per cent admitted to accepting such gifts “sometimes,” and 8% did so “often”.
  • Generic name prescription was inconsistently applied: only 17.9 per cent always included generic names alongside brand names, while 40.6 per cent “sometimes” did, and 6.7 per cent never did.

Interpretation and Implications

The study highlights a troubling trend: simple distribution of ethical guidelines – often given to doctors upon registration – is insufficient. Without structured, ongoing education, these resources remain underutilized.

Moreover, gaps in ethical knowledge and practice were not isolated to Sri Lanka. Similar findings have been reported in other South Asian countries, including India and Pakistan, where the majority still demonstrate inadequate ethics knowledge despite awareness.

Compromised prescription habits, reluctance to involve chaperones, and acceptance of pharmaceutical incentives underscore the real-life ethical dilemmas and pressures faced by medical professionals.

Role models

Researchers strongly advocate for integrating regular, in-service medical ethics training – potentially through Continuous Medical Education (CME) programmes, regional academic forums, or professional bodies. Such initiatives could enhance both knowledge and ethical behaviour.

In addition, medical seniors and consultants serve as de facto role models. Their attitudes heavily influence junior doctors, suggesting that ethics training should also address mentorship and the “hidden curriculum” embedded in clinical culture.

According to the study, while Sri Lankan doctors show a positive attitude toward learning, a significant mismatch remains between ethical knowledge and everyday practice. To safeguard patient trust and professional integrity, healthcare systems must embed ethics more deeply into training and institutional culture.