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Lecture by Professor Omar Hasan Kasule Sr. for Year
4 medical students at Kharj University on May 21, 2013
1.0 BED-SIDE VISITS
The physician-patient interaction is both professional
and social. The bedside visit fulfills the brotherhood obligation of visiting
the sick. The human relation with the patient comes before the professional
technical relation. It is reassurance, psychological and social support, show
of fraternal love, and sharing. A psychologically satisfied patient is more
likely to be cooperative in taking medication, eating, or drinking. The
following are recommended during a visit: greeting the patient, dua for the patient, good encouraging
words, asking about the patient’s feelings, doing good/pleasing things for the
patient, making the patient happy, and encouraging
the patient to be patient, discouraging the patient from wishing for death, nasiihat for the patient, reminding the
patient about remembrance of God. Caregivers should seek permission before
getting to the patient. They should not engage in secret conversations that do
not involve the patient.
2.0 ETIQUETTE OF
THE PATIENT
The patient should express gratitude to the
caregivers even if there is no physical improvement. Patient complaints should
be for drawing attention to problems that need attention and not criticizing
caregivers. The patient should be patient because illness is expiation for
sins, kaffaarat, and Allah rewards
those who surrender and persevere. The patient should make dua for himself, caregivers, visitors, and others because the dua of the patient has a special
position with Allah. When a patient sneezes he should praise Allah and
the mouth to avoid spread of infections. It is obligatory for the attendants to
respond to the sneezer. The patient should try his best to eat and drink
although the appetite may be low. The caregivers can not force the patient to
eat. They should try their best to provide the favorite food of the patient. The believing patient should never lose hope
from Allah. He should never wish for death. The patient should try his
best to avoid anger directed at himself or others. Getting angry is a sign of
losing patience.
3.0 ETIQUETTE OF
THE CARE-GIVER
The caregiver
should respect the rights of the patient regarding advance directives on
treatment, privacy. access to information, informed consent, and protection
from nosocomial infections. Caregivers must be clean and dress appropriately to
look serious, organized and disciplined. They must be cheerful, lenient,
merciful, and kind. They must enjoin the good, have good thoughts about the
patients and avoid evil or obscene words. They must observe the rules of
lowering the gaze and khalwat.
Caregivers must
have an attitude of humbleness; They
cannot be emotionally-detached in the mistaken impression that they are being
professional. They must be loving and empathetic and show mercifulness but the
emotional involvement must not go to the extreme of being so engrossed that
rational professional judgment is impaired.
They must make dua for the patients because pre-determination,
qadar, can only be changed by dua..
They must seek permission, izin, when
approaching or examining patients. Medical care must be professional,
competent, and considerate.
Medical decisions
should consider the balance of benefits and risks. The general position of the
Law is to give priority to minimizing risk over maximizing benefit. Any
procedures carried out must be explained very well to the patient in advance.
The caregiver must never promise cure or improvement. Every action of the
caregiver must be preceded by basmalah.
Everything should be predicated with the formula inshallah, if Allah wishes.
The caregivers must
listen to the felt needs and problems of the patients. They should ask about
both medical and non-medical problems. Supportive care such as nursing care,
cleanliness, physical comfort, nutrition, treatment of fever and pain are as
important as the medical procedures themselves and are all what can be offered
in terminal illness. Caregivers must reassure the patients not to give up hope.
Measures should be taken to prevent nosocomial infections.
4.0 ETIQUETTE OF
INTERACTION BETWEEN GENDERS
Both the caregiver and patient must cover nakedness, awrat, as much as possible. However, the
rules of covering are relaxed because of the necessity, dharurat, of medical examination and treatment. The benefit, maslahat, of medical care takes
precedence over preventing the harm inherent in uncovering awrat. When it is necessary to uncover awrat, no more than what is absolutely necessary should be
uncovered. To avoid any doubts, patients of the opposite gender should be
examined and treated in the presence of others of the same gender.
The caregivers should be sensitive to the
psychological stress of patients, including children, when their awrat is uncovered. They should seek
permission from the patient before they uncover their awrat. Caregivers who have never been patients may not realize the
depth of the embarrassment of being naked in front of others.
Medical co-education involves intense interaction
between genders: Teacher-student, student-student, and teacher-teacher.
Interacting with colleagues of the opposite gender raises special problems: norms
of dress, speaking, and general conduct; class-room etiquette; social
interaction; laboratory experiments on fellow students; Clinical skills
laboratory: learning clinical skills by examining other students;
Medical personnel of opposite genders should wear
gender-specific garments during surgical operations because our culture frowns
on any attempt to look like the opposite gender.
Guidelines on interaction with patients of the
opposite gender should be followed. Taking history, physical examination,
diagnostic procedures, and operations should preferably be by a physician of
the same gender. In conditions of necessity a physician of the opposite gender
can be used and may have to look at the ‘awrat
or touch a patient. The conditions that are accepted as constituting dharuurat are: skills and availability.
5.0 DEALING
WITH THE FAMILY
Visits by the family fulfill the social obligation of joining the kindred
and should be encouraged. The family is honored guests of the hospital with all
the rights of a guest. The caregiver must provide psychological support
to family because they are also victims of the illness because they anxious and
worried. They need reassurance about the condition of the patient within the
limits allowed by the rules of confidentiality. The family can be involved in
some aspects of supportive care so that they feel they are helping and are
involved. They should however not be allowed to interrupt medical procedures.
Caregivers must be careful not to be involved in family conflicts that arise
from the stresses of illness.