By Dr. Sodipo Oluwajimi (FWACP), Consultant Family Physician and HOD Family Medicine department LASUTH
Synopsis
- Introduction
- Definition of Terms
- Humanness vs Dehumanization in Medicine
- Challenges in its Practice
- Process of applying Humanness
- Advantages of Humanness in Medicine
- Patients Bill of Rights
- Summary
Introduction
- There is increasing exodus of doctors from Nigeria to other countries due to a combination factors
- This has led to a shortage of doctors with increased work load and stress
- Unfortunately against the expected increase in remuneration and benefits for “ scarce doctors”, the opposite has been the case with attendant frustrations
- There has also been increasing incidences of litigation against medical doctors despite “best efforts” of doctors involved.
- This is in addition to multiple cases of physical assault against medical personnel including doctors
- All these has led to frequent hostility between doctors and patients and a feeling by drs that all the effort being put are not appreciated by patients
- There has also been increasing incidences of litigation against medical doctors despite “best efforts” of doctors involved.
- This is in addition to multiple cases of physical assault against medical personnel including doctors
- All these has led to frequent hostility between doctors and patients and a feeling by drs that all the effort being put are not appreciated by patients
“I wanted my physician to listen to my story of suffering, to recognize my plight and to engage with me on a deep emotional level.
If I had to stand on the precipice of death, then I wanted a physician who had the courage and … the common decency to
stand there with me.
This kind of care is what mattered most to me.” – Sheila Crow
“To most physicians, my illness is a routine incident in their rounds, while for me it’s the crises of my life. I would feel better if I had a doctor who at least perceived this incongruity”
– Anatole Broyard
What is humane care
Humane care is the use of a creative, personalized, holistic, effective care model, to provide physical, psychological, social and spiritual care to patients in the process of medical treatment
Humane care
Certain factors in the doctor-patient interaction translate to humane care
- Courtesy and friendliness
- Respect shown to patients
- Warmth and interest in the patient
- Consideration for the patient’s feelings
- Concern for the patient.
Humanism/Humaneness
- encompasses those attitudes and behaviours that emanate from a deep sensitivity and respect for others, including full acceptance of all cultural and ethnic backgrounds
- Further, humaneness is exemplified through compassionate, empathetic treatment of all persons while recognizing each one’s needs and autonomy
Humanity in Medicine
- Humanity in medicine shares an intimate connection with the concept of physician-patient relationship.
- Physician patient relationship should be included in the key ethical principles of
- respect for persons,
- autonomy (self-determination),
- beneficence (do good),
- non-maleficence (avoid evil),
- justice (allocation of resources).
Empathy
Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another’s position.
it reminds the other that we share in their humaneness
Patient centered clinical care
- This can be defined as quality health care achieved through a partnership between informed and respected patients , and their families and a coordinated health care team.
- It forms one of the core principles of evidence based medicine which mandates the synthesis of best available evidence from the literature with the clinicians expertise and patients own inclinations.
Dehumanizing care
- explores the patient’s main reason for the visit, concerns, and need for information
- seeks an integrated understanding of the patient’s world—that is, their whole person, emotional needs, and life issues;
- finds common ground on what the problem is and mutually agrees on management
- enhances prevention and health promotion;
- enhances the continuing relationship between the patient and the doctor
Dehumanization In Medical Contexts
- Deindividuation:
- Patient is perceived as lost in a group and anonymized.
- This institutional practice, inhibits the search for idiosyncratic traits curbing the discovery of specific uniquely human or human nature traits in individual patients
Dehumanised Care
- In the hospital environment, patients are objectively incapacitated for different reasons (diseases or mental disorders) and so are more dependent on others than healthy people.
- This common attribute of lower autonomy may induce the perception that patients are less characterized of uniquely human traits, such as self-control and the capacity to plan one’s actions than healthy people
- Attribution of a lower human status to patients is a largely unconscious effect
- The higher the caregivers’ dehumanizing perceptions are, the worse patient/caregiver communication with its attendant negative effects on the extent to which patients follow medical recommendations
Common assumptions about disease in reductionist model
- Disease refers to disorder of organ within the body
- i.e. Disease is malfunction of part of whole
- All symptoms and illnesses are attributable to disease
- i.e. A person with symptoms is ill and must have an underlying disease within body
- All disease causes symptoms and illness
- i.e. Sooner or later disease manifests itself
Biomedical model
- Incorporates other assumptions:
- Patient is passive:
- A ‘victim’ of disease, and
- A ‘recipient’ of treatment
- Mental phenomena are separate domain unrelated to ‘physical’ phenomena
- ‘physical symptoms/signs’ are not caused by ‘mental’ processes
- Patient is passive:
Objectification of Patients
- Treating patients as mechanical systems and focusing on one body part, without considering the whole organism and patient’s mental states.
Why Dehumanising Care
- Patient dehumanization allows physicians and nurses to attenuate the stress which derives from perceiving patients’ physical and psychological pain.
- Dehumanization can finally serve the function of diminishing the feelings of guilt that arise from inflicting pain on others
- Using dehumanization to reduce stress may have beneficial effects on caregivers’ well-being, but not on their relationships with patients and patients’ physical and psychological well-being.
- It is a dysfunctional way of coping with stress when organizational measures should be taken
- -such as reduced workload
- -stronger organizational support.
Characteristics of a Humane Health Professional
- Integrity: the congruence between expressed values and behavior
- Excellence: clinical expertise
- Collaboration & Compassion: awareness and acknowledgement of the suffering of another and the desire to relieve it
- Altruism: the capacity to put the needs and interests of another before your own
- Respect & Resilience: the regard for the autonomy and values of another person
- Empathy: the ability to put oneself in another’s situation, e.g., physician as patient
- Service: the sharing of one’s talent, time and resources with those in need; giving beyond what is required.
How to practice Empathy
Are Humanities Taught In Medical School
- “Little did I realize that a couple of years later the patients I wanted to “serve” would be reduced to “an excellent hemiplegia case” or “a great hernia case”.
- By saying “excellent” and “great”, I was not, in any way, wishing ill for the patient. I was just describing my reaction to a case which I could learn new concepts from (Gupta).
- “From a medical perspective, when we are faced with routine everyday conditions, something unusual and dramatic is, well really cool.
- To the patient, however, it is anything but that. But who cares? Once the “excellent” case was presented to the consultant in the all important “clinic”, the “case” was forgotten in haste. Over to the next case!!! (Gupta)
Are Medical Students Losing Compassion during Training
- Empathy significantly decreased during medical education (P < .001), especially after the first and third years. (Callousness was seen as bad, but students saw it in their mentors 20% of the time in years 3 and 4, California, USA (Rentmeester).
- The deliberate practice of humanistic characteristics are not all innate and could be taught and learnt promising a sustainable humanistic practices in the medical profession
Survey on Medical Students in the US
- Hypothesis: Medical students with higher exposure to the humanities would report higher levels of positive physician qualities (e.g., wisdom, empathy, self-efficacy, emotional appraisal, spatial skills), while reporting lower levels of negative qualities that are detrimental to physician well-being (e.g., intolerance of ambiguity, physical fatigue, emotional exhaustion, and cognitive weariness. (Mangione)
Key Results
- Regression analyses revealed that exposure to the humanities was significantly correlated with positive personal qualities, including empathy (p < 0.001), tolerance for ambiguity (p < 0.001), wisdom (p < 0.001), emotional appraisal (p = 0.01), self-efficacy (p = 0.02), and spatial skills (p = 0.02).
- it was significantly and inversely correlated with some components of burnout (p = 0.01).
Challenges to Practice of Humanism in Medicine
- Attitude issues – prejudice, being judgemental
- Attitudes and behaviour of others
- Difficulty getting to work
- Not getting paid
- Expectations of patients, relatives, colleagues, employer
- Excess workload
- Stress and burn out
- Personal problems e.g. family or health
- Organisational issues e.g. Lack of resources, staff shortage, diary clashes
- Disappointments, false promises
- Lack of appreciation
- Time constraints
- Poor Knowledge
- Difficult patients
- Favoured use of advanced diagnostic equipment Improper uses of these technologies make diagnosis and treatment more impersonal.
Factors that Help Us Retain Our Humanness
- Faith
- Good health
- Tolerance/acceptance
- Good teamwork
- Appreciation from individuals, our Church/Mosque and community
What Factors Help Us Retain Our Humanness
- Being respected
- Selflessness
- Motivation from good salary
- Co-operative environment
- Honesty in others
- Career progression if doing well
- Practicing some form of music, art etc ( ie humanities)
Advantages of Humanness in Practice
- The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease
- better amount and quality of information about the patient’s disease transferred in both directions
- enhancing accuracy of diagnosis
- increasing the patient’s knowledge about the disease and adherence.
- More patient enablement (the ability of patients to act to improve their own health)
Advantages of Humanness in Practice
- Counteracting professional burnout
- Reducing biomedical concept
- Equipping doctors to meet
moral challenges
not “covered” by biomedicine
Advantages of Humanness in Practice
- Facilitating interdisciplinary teaching and research
- Promoting a patient-centered approach to medical care; When healthcare professionals give humanistic care there is better health outcomes. (Stewart)
- Reduced Litigation against health professionals
Advantages of Humanness
- Patients’ perception of physician’s empathy is associated with various improved health outcomes
- give fuller histories, disclosing more improved patient satisfaction
- Increased adherence to treatment
- Fewer malpractice complaints
- Increased physician health, well-being, and professional satisfaction
Patients’ Bill of Rights
Patients Bill of Rights in Nigeria
- Launched on the 31st July 2018
- A patient’s bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration.
- Typically a patient’s bill of rights guarantees patients information, fair treatment, and autonomy over medical decisions, among other rights.
Patients Bill of Rights in Nigeria
Rights every patient is entitled to according to the document
1. Right to relevant information,
2. Right to timely access to medical records,
3. Right to transparent billing
4. Right to privacy
5. Right to clean healthcare environment
6. Right to be treated with respect.
7. Right to receive urgent care
8. Right to reasonable visitation
9. Right to decline care
10. Right to decline or accept to participate in medical research
11. Right to quality care
12. Right to complain and express dissatisfaction regarding services received.
‘The greatest challenge facing contemporary medicine is for it to … regain its humanity, its caritas — without losing its essential foundation in science … to find a middle way.’ Willis JAR. The sea monster and the whirlpool. Keynote address. Birmingham: Royal College of General Practitioners; 2002
“We need health professionals who are technically competent, but who can also demonstrate the virtues of compassion and empathy.
In most of medicine, technical versus caring skills is a false dichotomy. Taking a blood sample or performing a surgery are not simply objective tasks. You can do them in ways which are empowering and soothing, or you can do them in ways which are demeaning and disrespectful.
It’s not what you do, it’s the way you do it”
– BBC News Magazine
Summary
- There is a gradual loss of Humanness in the practice of Medicine
- Beyond clinical skills, its important to practice Humanness to improve health outcomes and patient satisfaction
- A patient bill of Rights has been launched in Nigeria, we await Doctors/Health practitioner bill of rights
- Lets partner to provide humane care today irrespective of challenges
HUMANNESS is not mere handholding.
It is good medicine.”
References
- Newmann M, Edelhauser F, Emapthy decline and its reasons :a systematic review of studies with medical students amd residents . Acad Med: 2011; 86. 996-1009
- Stewart M. The impact of patient centered care on outcomes . The journal of family practice; September 2000;49(9)
- Decksen F. A systematic review . BJGP 2013. 63(606):76-81
