Unit.5.2.Health Profession

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Unit: V.2.

Health Profession Sociology for Health Sciences

Unit: 5.2. Health Profession


Dr. G. Pitchaimani B.P.T., M.SC., PhD
Content
 Professions and Professionalization
 Professional Socialization
 Professionalization of Physician
 Doctor-Nurse Relationship
 Doctor-Patient Relationship
 Nurse-Patient Relationship

1. The Professionalization and Socialization of The Physician


Professionalization
 Within sociology the term ‘profession’ is usually used to denote a type of occupation
accorded high status and a high degree of autonomy over its work; with medicine
being regarded as an example.
 ‘Professionalization’ refers to the process of achieving the status of a profession.
 Professionalism is service orientation and training in a specialized body of knowledge
Medicine is considered to be the Classic Example of a Profession
 The term Professionalism embraces a set of attitudes, skills and behaviours, attributes
and values which are expected from those to whom society has extended the privilege
of being considered a Professional.
 The underlying assumption that necessitates professionalism in medicine is the
understanding that practicing medicine is a moral endeavour, requiring a rigorous
application of behavioural and ethical standards in combination with scientific
training and the ability to care for humans in distress with compassion and empathy.
Definition
Professionalism in Medicine
 Professionalism in medicine requires the physician to serve the interests of the patient
(and community) above his or her self-interest.
 Professionalism aspires to altruism, accountability, excellence, duty, honour, integrity,
and respect for other.
Elements of Professionalism
 Altruism is the essence of professionalism. The best interest of the patients, not self-
interest, is the rule.
 Accountability is required at many levels - to individual patients, society and the
profession.
 Excellence entails a conscientious effort to exceed normal expectations and make a
commitment to life-long learning.
 Duty is the free acceptance of a commitment to service.
 Honour and integrity are the consistent regard for the highest standards of behaviour
and refusal to violate ones personal and professional codes.

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Unit: V.2. Health Profession Sociology for Health Sciences

 Respect for others (patients and their families, other physicians and professional
colleagues such as nurses, medical students, residents, subspecialty fellows, and self)
is the essence of humanism"
Socialization
 Socialization is the lifelong process of interaction through which individuals acquire a
self-identity and the physical, mental, and social skills needed for survival in society.
 W.H. Ogburn says “Socialization is a process by which the individual learns to
conform to the norms of the group”.
 Bogardus define “Socialization as the process of working together, of developing
group responsibility, of being guided by welfare needs of others”.
The Socialization of the Physician
 Process to become a doctor is long, difficult and costly
 Medical students go through a socialization process
 Need to learn how to tolerate uncertainty
 Increasing diversity in medical school
 Changes in conceptualization of medicine and medical practice effect education
Professionalism
Role of the doctor within the health service
 Understanding of the health care system
 Understanding of clinical responsibilities
 Appreciation of doctor as researcher
 Appreciation of doctor as mentor or teacher
 Motivation
 Appreciation of doctor as manager including quality control
 Team working
Personal Development
 Lifelong Learner
 Self confidence
 Self awareness
 Self regulation
o Self care
o Self control
o Personal time
o Management
 Motivation
o Achievement drive
o Commitment
o Initiative
 Career choice
Commitments of Professional Doctor
 To professional competence
 To honesty with patients
 To patients’ confidentiality
 To maintaining appropriate relationships

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Unit: V.2. Health Profession Sociology for Health Sciences

 To improving quality of care


 To improving access to care
 To scientific knowledge
 To professional responsibilities
Commitments as a Professional Medical Student
 Respect for professors and peers
 Respect for the institution of which you are a part
 Respect for patients and their families at clinical encounters
 Respect for patient confidentiality
 Respect for all members of the health care team
 Respect for administrative and support staff
 Respect for the core values of professionalism
Lack of Professionalism
1. Abuse of power:
 Abuse while interacting with patients and colleagues
 Bias and sexual harassment
 Breach of confidentiality
2. Arrogance (offensive display of superiority and self-importance);
3. Greed (when money becomes the driving force);
4. Misrepresentation (lying, which is consciously failing to tell the truth; and fraud,
which is conscious misrepresentation of material fact with the intent to mislead);

2. Doctor Patient Relationship


Doctor-Patient relationship is an emotional association between the doctor & patient
which arises when the doctor interacts with a patient to alleviate their sufferings and prevent
illness.
 The patient-physician relationship is fundamental for providing
1. Excellent care
2. To the healing process
3. To improved outcomes
 Therefore, it is important to understand what elements comprise the relationship
and identify those that make it "good."
Patient
 Is a human being seeking help to improve their health or prevent disease. He always
carries a degree of fear or anxiety.
Doctor
 Is a skilled professional with leadership, emotional intelligence and strong
communication skills.
A Good Doctor-Patient Relationship
 A good communication skills help in gathering information & exploring the problem
better.
 Developing an understanding of the patient as an individual, not as a disease.
 Showing empathy and respect.

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Unit: V.2. Health Profession Sociology for Health Sciences

 Listening attentively & creating a partnership.


 Answering questions honestly.
 Involving patient in decision making.
 Demonstrating sensitivity to patients cultural & ethnic diversity.
Respect for patients’ wishes (informed consent)
 Patients must have a choice in the provision of their care and be given the right to
provide informed consent to medical procedures.
Shared Decision Making
 Shared decision making is the idea that as a patient gives informed consent to
treatment, that patient also is given an opportunity to choose among the treatment
options provided by the physician that is responsible for their healthcare.
Physician Superiority
 The physician may be viewed as superior to the patient simply because physicians
tend to use big words and concepts to put him or herself in a position above the
patient.
 A physician should be aware of these disparities in order to establish a
good rapport and optimize communication with the patient.
Benefiting or Pleasing
 A dilemma may arise in situations where determining the most efficient treatment, or
encountering avoidance of treatment, creates a disagreement between the physician
and the patient, for any number of reasons.
 In such cases, the physician needs strategies for presenting unfavourable treatment
options or unwelcome information in a way that minimizes strain on the doctor–
patient relationship while benefiting the patient's overall physical health and best
interests.
Transitional Care
 Transitions of patients between health care practitioners may decrease the quality of
care in the time it takes to re-establish proper doctor–patient relationships.
 Generally, the doctor–patient relationship is facilitated by continuity of care in regard
to attending personnel.
 Special strategies of integrated care may be required where multiple health care
providers are involved.
Other Involved Individuals
 An example of where other people present in a doctor–patient encounter may
influence their communication is one or more parents present at a minor's visit to a
doctor.
 These may provide psychological support for the patient, but in some cases it may
compromise the doctor–patient confidentiality and inhibit the patient from disclosing
uncomfortable or intimate subjects.
Bedside Manner
 A good bedside manner is typically one that reassures and comforts the patient while
remaining honest about a diagnosis.
 Vocal tones, body language, openness, presence, honesty, and concealment of attitude
may all affect bedside manner.

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Unit: V.2. Health Profession Sociology for Health Sciences

 Poor bedside manner leaves the patient feeling unsatisfied, worried, frightened, or
alone.
Patient Behaviour
 The behaviour of the patient affects the doctor–patient relationship.
 Rude or aggressive behaviour from patients or their family members can also distract
healthcare professionals and cause them to be less effective or to make mistakes
during a medical procedure.
 When dealing with situations in any healthcare setting, there is stress on the medical
staff to do their job effectively. Whilst many factors can affect how their job gets
done, rude patients and unappealing attitudes can play a big role.
Types of Doctor Patient Relationship
Four types of Doctor-Patient Relationship
 Paternalism
 Consumerism
 Mutuality
 Default
Controlled Based Doctor-Patient Relationship
 Doctor controlled
 Patient controlled

Prototypes of Doctor Patient Relationship

Physician control
Relationship
Low High
Low Default Paternalism
Patient Control
High Consumerism Mutuality

1. Paternalism
 Traditional form of doctor-patient relationship
 Doctor takes on role of parent
 Doctor is the expert and patient expected to cooperate
 Tightly controlled interviewing style aimed at reaching an organic diagnosis
 A Passive patient and a dominant doctor
 Focus is on care, rather than autonomy
Advantages of Paternalism
 The supportive nature of paternalism appears to be important when patients are very
sick at their most vulnerable.
 Relief from the burden of worry is curative in itself, and the trust and confident
implied by this model allows doctor to perform “medical magic”.
Disadvantage of Paternalism
 Manipulation and exploitation of the vulnerable and ill.

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Unit: V.2. Health Profession Sociology for Health Sciences

2. Mutuality
 The optimal doctor-patient relationship model
 This model views neither the patient nor the physician as standing aside
 Each of participants brings strengths and resources to the relationship
 Based on the communication between doctors and patients
Patients
 Patients need to define their problems in an open and full manner.
 The patient has right to seek care elsewhere when demands are not satisfactorily met.
Physicians
 Physicians need to work with the patient to articulate the problem and refine the
request.
 The physician’s right to withdraw services formally from a patient if he or she feels it
is impossible to satisfy the patient’s demand.
Advantages of Mutuality Approach
 Patients can fully understand what problem they are coping with through physicians’
help
 Physicians can entirely know patient’s value
 Decisions can easily be made from a mutual and collaborative relationship
Disadvantages of Mutuality Approach
 Physicians do not know what certain degree should they reach in communication
 Is the patient capable of making the important therapeutic decisions
3. Consumerism
 We can simplify the complicated relationship with “buyer and seller” relationship.
 The patient can challenge to unilateral decision making by physicians in reaching
diagnosis and working out treatment plans
 Reversing the very basic nature of the power relationship
Patient:
 Health shoppers so consumer behaviour
 Cost-consciousness
 Information seeking
 Exercising independent judgment
Doctor:
 Health care providers
 Technical consultant
 To convince the necessity of medical services
Advantages of Consumerism
 Patients can have their own choices.
Disadvantages of Consumerism
 When things seem to go wrong, when satisfaction is low, or when a patient suspect
less than optimal care or outcome, patients are more likely to question physician
authority.

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Unit: V.2. Health Profession Sociology for Health Sciences

4. Default
 When patient and physician expectation are at odds, or when the need for change in
the relationship cannot be negotiated, the relationship may come to a dysfunction
standstill.
Patient Controlled Consultation
 “You’re paid to do what I tell you!!”

Doctor Controlled Consultation

Patient Centred Consultation Style


 Dr is less authoritarian , encourages patients to express their own feelings and
concerns , empathic , listen more than talk
 Dr use open end questioning , show interest in psycho-social aspect of patient’s illness

Doctor-Patient Relationship in The Past


 Paternalism
 Because physicians in the past were people who have higher social status
 “Doctor” is seen as a sacred occupation which saves people’s lives
 The advices given by doctors are seen as paramount mandate.

Doctor-Patient Relationship at Present


 Consumerism and mutuality
 Patients nowadays have higher education and better economic status
 The concept of patient’s autonomy
 The ability to question doctors

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Unit: V.2. Health Profession Sociology for Health Sciences

Seven Essential Elements in Physician-Patient Communication


1. Build the doctor-patient relationship
2. Open the discussion
3. Gather information
4. Understand the patient’s perspective
5. Share information
6. Reach agreement on problems and plans
7. Provide closure
Conclusion
 Relationship between patients and doctors are often unstated, and thy are dynamic
 As conditions change, the kind of relationship that works best for a patient may
change.
 Doctors and patients should choose a “relationship fit”.
 Effectiveness of the patient-physician relationship directly relates to health outcomes.
 A good doctor-patient relationship is recognised by the health care providers and the
patients as an essential tool in providing high quality medical care.
 Goal of consultation is not only to arrive at diagnosis and formulating a treatment
plan. But also, to develop common understanding between patient and doctor.

3. Nurse Patient Relationship


Nursing
 Florence Nightingale (12 May 1820 – 13 August 1910) was a celebrated English
social reformer and statistician, and the founder of modern nursing.
What is Nursing
 Nursing is the protection, promotion, and optimization of health and abilities,
prevention of illness and injury, facilitation of healing, alleviation of suffering
through the diagnosis and treatment of human response, and advocacy in the care of
individuals, families, groups, communities, and populations.
Task of Nursing
The tasks of nursing are:
 To promote health
 To prevent disease
 To help ill-person to healing (to assist healing)
 To assist the dying patient to pass away with quietude, peace, and dignity (to ease
suffering).
 Nurse-patient relationship is a supportive interaction that moves a patient toward
wellness. It's based on trust, respect, interest, and empathy.
Nurses’ roles in Nurse-patient relationship
 Care giver
 Counselor
 Educator
 Consultant
 Researcher

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Unit: V.2. Health Profession Sociology for Health Sciences

Characteristics of Good Nurse-patient Relationship


 Relationship is therapeutic
 Exist until patient have fulfilled the health care needs
 Nurses’ work is to attain, maintain, and restore the patients’ health
 Patients are satisfied, Based on nurses’ competent care derived from skills and
knowledge
 Provide holistic care
 Patient/client is an active participant
 Nurse uses patients’ knowledge, attitudes, values, and thoughts to plan interventions
 Reciprocal relationship influenced by professional and personal characteristics of both
parties
4. Doctor Nurse Relationship
 Good relationships between nurses and physicians are important to high-quality patient
care.
 Historically, the doctor-nurse relationship has been an unequal one characterized by the
dominance of the doctor, with the nurse assuming a position of lower status and
dependence on the physician
 A negative or intimidating relationship between a physician and a nurse can create a
situation that puts the patient at risk.
 Nurses promote patient safety in part by communicating with physicians.
 Effective collaborative efforts and clear communication improves the quality of patient
care in the work environment.
 Poor communication between physicians and nurses leads to misunderstandings, errors,
and ongoing conflict between nurses and physicians. Ultimately, quality patient care is
jeopardized.
 Collaboration between nurses and physicians is essential in facilitating improved patient
care outcomes and patient care satisfaction.
 The benefits of effective nurse/physician relationships include decreased cost, better
patient care, and decreased patient morbidity and mortality.
 Additional benefits are improved communication among health care workers, improved
efficiency, improved understanding of the nursing role, and decreased patient length of
stay.
 Increasing opportunities for nurses and physicians to interact with each other also
increases the likelihood of developing collaborative, interactive relationships.
 Likewise, nurses and physicians must engage with each other away from the bedside.
With increased exposure comes the association of names with faces rather than just room
numbers with scrub colours.
 Concerning interdisciplinary rounds, although unforeseen circumstances can occur,
having rounds on specific days and times can help ensure members of each discipline can
be available.

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