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Background reading
material by Professor Omar Hasan Kasule Sr.
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, prayer 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, advice for the patient, and
reminding the patient about religious obligations. Caregivers should seek
permission before touching or examining 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 there are blessings for those
who surrender and persevere. The patient should make pray for himself,
caregivers, visitors, and others. 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. 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 must avoid being alone with patients of the opposite gender. 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 prayer for the patients. They must seek permission 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. 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
UNCIOVERING THE NAKEDNESS OF PATIENTS
Both the caregiver and patient must cover nakedness as
much as possible. However, the rules of covering are relaxed because of the
necessity of medical examination and treatment. The benefit of medical care
takes precedence over preventing the harm inherent in uncovering nakedness.
When it is necessary to uncover nakedness 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 nakedness is uncovered. They should
seek permission from the patient before they uncover their nakedness.
Caregivers who have never been patients may not realize the depth of the
embarrassment of being naked in front of others.
5.0
ETIQUETTE OF INTERACTION BETWEEN DIFFERENT GENDERS
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
and learning clinical skills by examining other students; and standing together
in a crowded operation theatre. Specific regulations should be in place dealing
with all these issues.
Legal 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 nakedness or touch a patient. The
conditions that are accepted as constituting necessity are: skills and
availability.
6.0 DEALING
WITH THE FAMILY
Visits by the family fulfill the social obligation of joining the kindred
and should be encouraged. The families are 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.