Prof Dr Omar
Hasan Kasule Sr. MB Ch B (MUK), MPH (Harvard), DrPH (Harvard) Department of
Bioethics KFMC presented at the 5th International Nursing Symposium under
the theme 'Nursing Innovations and Excellence in Patient and Family Centered
Care ' held at the Main Auditorium on 26th March 2012
1.0 OLD TIMES
Slide showing ancient picture of
patient surrounded by doctors and family
2.0 MODERN TIMES
Slide showing doctor with patient
in a high-tech environment he is busy with machines or lap top and not paying
attention to the patient
3.0 SOS (SAME OLD STUFF)
· ‘plus
que ca change plus que c’est la meme chose’
·
7000 years ago: patient-centered and
family-centered, integrated and balanced; limited technological input, home
based care herbs + spiritual + TLC
·
100 years ago: Biomedical (BM) model:
disease-centered technology-based ignored the mind, emotions, spirit
·
35 years ago: Biopsychosocial (BPS) model:
reintroduced the psychosocial dimension
·
Today: Holistic care (HC) model: total care
·
Today: Patient-centered
(PCC) model: individualized care
4.0 ANCIENT MEDICINE: integration
and balance
· Mesopotamian
medicine: magico-religious + physical
remedies
· Ancient Egyptian medicine: mystical, priestly + physical remedies +
surgery
· Ancient Chinese medicine: balance (yin & yang) and balance among
the 5 elements: wood, fire, earth, metal, water). + herbal + acupuncture +
massage + diet + mental + physical exercises
·
Ancient
Indian medicine: Balance among three elementary substances
representing divine forces: spirit (air), phlegm, and bile that produce the
contents of the body + diet, hygiene, mental prep, herbs + surgery
5.0 GRECO-ROMAN MEDICINE:
integration and balance
· Closely related to religions and the temples.
· Balance of 4 humors (blood, phlegm, yellow
bile, and black bile), 4 elements (earth, air, fire, and water), and 4
qualities (hot vs. cold and wet vs. dry).
· Disease treatment directed to restoration of
the balance.
· Rest and diet were used in treatment.
6.0 ROOTS OF THE BM MODEL
· Rudolf Carl Virchow (1821-1902)- cell theory à cellular basis of disease
· The microbial basis of disease became firmly
established when Louis Pasteur (1822-1895) and Robert Koch (1843-1900)
developed the germ theory through experimentation.
· Anti-microbial agents: salvasan for syphilis
by Paul Ehrlich (1854-1915), sulfonamides by Gerhard Johannes Domagk
(1895-1964), penicillin by Sir
Alexander Fleming (1881-1955)
· By 1920: Single axis: cause-disease-treatment
7.0 CHARACTERISTRICS OF THE BM
MODEL…1
·
Focus on the physical and rejection of the
psychosocial and spiritual
·
Focus on disease and not illness
·
Physician sees organ pathology and not the whole
patient
·
Commodization of health & medicalization of
life
·
Demystification of the human body
8.0 CHARACTERISTRICS OF THE BM
MODEL…2
·
Dehumanization of the patient: 'thing' 'machine'
·
Depersonalization of the patient: case, number,
pathology
·
Control of decisions in the hands of the physician
·
Lack of balance in disease definition and
disease treatment
· Can
not explain illnesses with multiple cause and no simple cure
9.0 THE BIOPSYCHOSOCIAL (BPS)
MODEL
· Alternative
to the BM model first described in 1977
· Integration biological, psychological,
social, emotional, religious factors, and patient factors in disease
understanding, treatment and prevention
· Call for research, education, and practice
to address health and not illness
· Consider interrelations among Xple disease
causes
·
Take
into account the social network of the patient
10.0 HOLISTIC CARE (HC) MODEL
· Term holistic coined in 1926 from Greek
halos meaning all or whole
· Opposite of reductionism: understanding by
breaking apart
· Body operates as a whole cannot be
understood as parts
· Social, psychosomatic, spiritual, emotional
dimensions
· Complementary and alternative medicine
·
Requires
cultural competence
·
Concept of total care for the body as a
physiological entity (prophetic hadith)
11.0 PATIENT CENTERED CARE (PCC) MODEL
·
The patient is final common pathway for all
models
·
Rrespect
for the patient and the family by incorporating their desires in treatment
·
Looking at care from the vantage point of the
patient
·
Doing the best for the patient even of routines
are changed
·
It integrates and individualizes care
· Requires
cultural competence
12.0 PHYSICIAN ETIQUETTE AT
THE BEDSIDE …1
· The physician-patient interaction is both professional
and social.
· The human relation before the professional technical
relation.
· The bedside visit is a brotherhood duty visiting the
sick, 'iyadat al maridh.
· Reassurance, psychological and social support, love,
and sharing.
· Seek permission, isti'dhaan
· Every action of the caregiver must be preceded by basmalah.
· Everything should be predicated with the formula inshallah,
13.0 PHYSICIAN ETIQUETTE AT
THE BEDSIDE …2
· Greeting the patient, salam
· dua for the patient
· Good encouraging words
· Asking about the patient’s feelings
· Doing good/pleasing things for the patient
· Making the patient happy
· Encouraging the patient to be patient
14.0 PHYSICIAN ETIQUETTE AT
THE BEDSIDE …3
· Discouraging the patient from wishing for death
· Sincere advice, nasiihat
for the patient
· Reminding the patient about dhikr.
· good thoughts about the patients, husn al dhann
· Caregivers must have an attitude of humbleness, tawadhu'u
· No secret conversations, najwa
· Empathy; no emotional detachment to be professional
15.0 DEALING WITH THE FAMILY
· Family visits are a social obligation and are
encouraged
·
The
family members are honored guests with all the shari’at rights of a guest.
·
Family needs psychological support; they are
anxious and worried
·
Family reassurance about the patient without
breach of confidentiality
·
Involving the family in some support care gives
them pleasure
·
Family visits should not interrupt routines and
procedures
·
Caregivers must avoid involvement in family
conflicts.
16.0 ETIQUETTE
WITH THE DYING
· Comfort: pain relief, communication, hygiene,
wudhu all the time
· 'Ibadat-friendly hospital
· Spiritual preparation: allay anxiety, present
death as a positive event
· Legal preparation: debts and a will
· Prepare family for mourning
17.0 THE TAUHIDI
PARADIGM
·
Lack of integration due to atomistic view of the
cosmos: analytic but not synthetic
·
Integration is not addition but is fitting
according to the laws, sunan
·
Problems of BM, BPS, HC, and PCC due to lack of
an integration paradigm
·
The tauhidi paradigm provides a
conceptual basis for integration.
·
Tauhid al rububiyyat = once Creator for
the cosmos = all things must relate to and integrate with one another if we
know the laws, sunan, to follow.
·
Integration calls forth balance among the
components integrated.