990527P - THE TEACHING OF COMMUNICATION SKILLS AT UIA

Paper presented at a workshop on 'Teaching of Bio-ethics and Communication Skills in Medical Education- A Malaysian Model' organized by the School of Medical Sciences, Universiti Sains Malaysia, Kuban Kerian, Kelantan 26-27^th May 1999 by Prof Omar Hasan Kasule, Deputy Dean for Research and Post Graduate Affairs, UIA.

ABSTRACT

Training in communication skills could be a form of hypocrisy when people learn to talk and behave in acceptable ways for the purpose of their work and they behave differently outside. Communication skills are part of social etiquette and can not be taught in isolation. They are part of the teaching of Islamic social etiquette. The Islamic etiquette between patients and care-givers is the same etiquette between any other members of the society and is deeply rooted in the concept of Islamic brotherhood, ukhuwwah islamiyyah. Islamic brotherhood is an all-embracing concept that requires fulfill duties and obligations to all humans whether Muslim or non-Muslim and whether close or not. The Islamic Input Curriculum (IIC) covers all aspects of etiquette either in formal class-room teaching or as part of the general Islamic organizational culture that is fostered in the kulliyah of medicine. This paper presents examples of teachings about etiquette as an illustration: etiquette with patients, etiquette with the dying, and etiquette with colleagues.

Key words: islamic social etiquette

Internet adress: download whole paper from http://www.iiu.edu.my/studyislam.htm

1.0 ETIQUETTE WITH PATIENTS

Obligation to visit the patient, wujuub iyadat al mariidh: The physician rounds fulfil one of the social obligations of visiting the sick (KS 505).  Visiting the sick is considered one of the excellent acts, fadhl iyadat al mariidh, (KS 505). The physician gets a lot of reward from Allah for fulfilling this social obligation in addition to the rewards for his medical work. The physician should interact with the patient as a fellow human. The human relation has priority over the patient-physician relation. Some bed-side visits should therefore be purely social with no medical procedures or medical discussions. Physicians should similarly realize the importance of visits by relatives and friends and should plan their ward routines to maximize such visits.

The  manner of the Prophet's visits to patients: The behavior of the Prophet at the bedside of the patient is good guidance for both the physician and the other visitors to the patient. The prophet regularly visited his companions who fell sick (KS 505). The books of sirah have preserved for us memories of such visits such as what the prophet said during the visit (KS 505).

Etiquette of visiting a patient, adab ‘iyadat al mariidh: The following are recommended actions during a visit to the patient: dua for the patient (KS 505), reading Qur'an for the patient (KS 505), and asking the patient for dua. The sunnah gives us guidance on what can be said in the presence of the patient (KS 505): asking about the patient’s feelings, suaal anhu, doing good/pleasing things for the patient (ihsaan), making the patient happy, tatyiib nafs al maiidh, encouraging the patient to be patient, tashjiu al mariidh (KS 505)., and discouraging wishing for death wishing death,  tamanni al mawt (KS 524).

Medical care: Care must be professional, competent and considerate. The care-giver must listen to the patient and solve outstanding medical and non-medical problems.

Choice of physician and treatment: As long as the patient is conscious and is in full control of mental faculties, he should be consulted about choice of physicians and treatment modalities. The freedom of choice is Newborns. Freedom of patient to choose physician: the order of priority is: Muslim of the same gender, non-Muslim of the same gender, Muslim of opposite gender.

Choice of treatment, food, and drink: The sunnah has given us guidance about forced feeding and forced treatment (KS 505). The patient retains freedom to accept treatment or to reject it. The patient can not be forced to take any medication. Treatment with new/experimental drugs or procedures require informed consent. If the patient has lost legal capacity, ahliyat, by being unconscious or by losing mental capacity, the guardian, waliy, will take binding decisions on behalf of the patient.

Control of infections: Measures must be taken to control the spread of contagion, al adwah. The prophet forbade a sick visiting the healthy (KS 504). Care-givers with infectious conditions must get adequate treatment and should refrain from contact with the patients.

Confidentiality: The physician and other health care givers should not broadcast any confidential information that they obtain in the course of their work.

Communicating bad news to the patient: No general guidelines can be given on this matter. Each case should be considered on its own merits. In general the decision is based on consideration of the balance of positive and negative impacts. The Principles of the Law, al qawaid al fiqhiyyat, can be used as a guideline.

2.0 ETIQUETTE WITH THE DYING

Making the dying patient comfortable: Narcotics are given for severe pain. Drugs are used to allay anxiety and fears. The caregivers should maintain as much communication as possible with the dying: patience. They should attend to needs and complaints and not give up in the supposition that the end was near. Attention should be paid to the patient's hygiene such as cutting nails, shaving hair, dressing in clean clothes. As much as possible the dying patient should be in a state of ritual purity, wudhu, all the time.

Ibadat: The dying patient should as far as is possible be helped to fulfil acts of worship especially the 5 canonical prayers. Physical movements should be restricted to what the patient's health condition will allow. There us guidance on salat even for the unconscious patient (KS 505)

Spiritual preparation. Death of the believer is an easy process that should not be faced with fear or apprehension. The process of death should be easier for the believer than the non-believer (KS 525). The soul of the believer is removed gently (KS 525, 525, 525).  Believers will look at death pleasantly as an opportunity to go to Allah. They should be told that Allah looks forward to meeting those who want to meet Him (KS 525). Dying with Allah's pleasure (KS 525) is the best of death and is a culmination of a life-time of good work. Thinking well of Allah is part of faith (KS 525) and is very necessary in the last moments when the pain and anxiety of the terminal illness may distract the patient's thoughts away from Allah. Having hope in Allah at the moment of death (KS 525) makes the process of dying more acceptable.

Helping patient make a  will: During the long period of hospitalization, the health care givers develop a close rapport with the patient. A relationship of mutual trust can develop. It is therefore not surprising that the patient turns to the care givers in confidential matters like drawing a will. The health care givers as witnesses to the will must have some elementary knowledge of the law of wills and the conditions of a valid will, shuruut al wasiyyat. One of these conditions is that the patient is mentally competent. The law accepts clear signs by nodding or using any other sign language as valid expressions of the patient's wishes. The law allows bequeathing a maximum of one third of the total estate to charitable trusts, waqf, or gifts. More than one third of the estate can be bequeathed with consent of the inheritors. Debts must be paid before death or before the division of the estate.

The last moments: The last moments are very important. The patient should be instructed such that the last words pronounced are the kalimat, the testament of the faith. Once death has occurred the body is placed in such a way that it is facing the qiblat. Eyes are closed and the body is covered. Qur'an and dua are then recited.

Etiquette of morning:  The health care giver should take the initiative to inform the relatives and friends. They should be advised about the shariah rules on mourning. Weeping and dropping tears are allowed. The following are not allowed: tearing garments, shaving the head, slapping the cheek, wailing, and crying aloud. On receiving the news of death it suffices to say ' we are for Allah and to Him we will return'(KS 525). Relatives are comforted by telling them hadiths of the prophet about death. These hadiths talk about the reward of the person who loses his beloved one and he is patient (KS 524) and the excellence of one who loses three children (KS 524).

Preparation for burial:  The health care team should practice total care by being involved and concerned about the processes of mourning, preparation for burial and the actual burial. They should participate along with relatives as much as is possible. The body must be washed and shrouded before burial. The washing should start with the right. The organs normally washed in wudhu are washed first then the rest of the body is washed. Perfume can be used and women's hair has to be undone. After washing the body is shrouded, kafn, in 2 pieces of cloth preferably white in color.

Accompanying the funeral procession, tash'yii an janazat:  Burial should not be delayed, ta'ajil bi al janzat (KS 161). Following the procession is enjoined (KS 159). There are big rewards for accompanying the funeral procession (KS 159). There is more reward for accompanying the funeral procession and staying until burial is completed (KS 160). The funeral bier is carried by men. Hurrying in marching to the grave is recommended.

3.0 ETIQUETTE WITH COLLEAGUES

General duties and rights of brotherhood:  The following are general duties of brotherhood that any colleague owes the others: returning greetings, following funeral processions, accepting invitations, visiting the sick, and responding to the sneezer.

Other duties to colleagues: tolerance, forgiveness, helping the oppressed, solving problems, fulfilling needs, compassion and kindness, protecting the honor of others, fulfilling promises, and commitments, respect for others, sincere advice, nasiiha, avoiding under-rating and humiliating others, and gratefulness.

REFERENCE:

Fuad Abdul Baqi. Miftaah Kunuuz al Sunnat (KS). Dar al Qalam. Beirut 1985.