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Prepared for presentation by Prof OHK MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Prof of Epidemiology and Bioethics King Fahad Medical City
SUMMARY
- KNOW YOUR PROFESSIONAL DUTIES AND RESPONSIBILITIES AND CARRY THEM OUT
- BE PROFESSIONAL
- LET YOUR CONDUCT BE DAWA
CANMEDS FOR MEDICAL EXPERT COMPETENCIES
DUTIES TO THE PROFESSION
- Respect the honour of the profession.
- Develop him/herself to develop the profession.
- Adhere to the standards of practice.
- Abstain from any behaviour/action that would question his/her credibility, or establish dishonest affairs with patients or their families.
- Avoid the request of fame on account of professional ethics and standards.
- To provide a role model for his colleagues and patients.
- Reflect sincere devotion and dedication to the medical profession.
- Avoid any action that could lead to contempt of the medical profession and to maintain the standards of medical profession.
- The physician should not take advantage of his professional position for obtaining any material or moral gains, which are not in conformity with or violate the laws and tradition.
- Take the appropriate action when he comes to know that one of the members of the health team is sick, ignorant or negligent of his duties; in furtherance of protecting the patient in the first place and the medical profession next.
- The physician should refrain, when dealing with the patient, from any act or conduct that would infringe his honesty and integrity.
DUTIES TO THE PATIENT
Treat your patient as a person, not just a body.
Respect your patient’s autonomy
Treat all patients equally, without discrimination.
Fear God when dealing with your patients; show respect for their beliefs, religions and traditions.
Ask only for the tests needed for the patient without adding any tests not justified by the patient’s case. A doctor should base his whole diagnosis and treatment on the best available evidence and data
Explain honestly to the patient or anyone representing him/her the type, causes, and complications of the illness, and of the usefulness of diagnostic and therapeutic procedures.
Relieve the patient’s pain and give him the feeling that the physician is eager to give him proper care and attention.
Respect for Privacy.
Respect for patient’s autonomy
Inform the patient about his/her condition.
Keep the patients’ secrets (confidentiality).
DO NOT hesitate to refer the patient to a more experienced doctor or to a doctor who has more effective equipment whenever the patient’s case calls for such a referral, nor to refer him to a doctor whom the patient wishes to consult.
Continue to give an emergency patient the proper treatment until it is no longer needed or until care for the patient is taken over by another doctor.
DUTY TO COLLEAGUES
To deal with, and act towards his/her colleagues in a good manner and in the same way he/she would prefer to be treated.
To avoid direct criticism to his/her colleague in front of patients.
Not to indulge in defaming the honor of his/her colleagues.
To exert every possible effort to educate the colleagues.
Respect the differences with colleagues (gender, culture, belief…).
The physician should respect other non-physician medical professional colleagues, and appreciate their roles in the healthcare of the patient.
He/she must report the incidence in which a colleague could be dangerous to the authority concerned
PROFESSIONALISM -Concept
Medical professionalism is poorly conceptualized and understood; therefore not easy to define.
As a concept and practice it has its own history and has been evolving.
The concept has different formulations depending on space-time variations.
Medical students get confused with apparently contradictory concepts of professionalism if they do not realize that they are dealing with different models of professionalism.
PROFESSIONALISM DEFINITION AS ATTITUDES AND BEHAVIORS
In general professionalism is defined as attributes and behaviors expected of a physician.
A fair level of agreement can be reached by physicians, nurses, and the public on tangible behaviors that constitute professionalism.
Behaviors are easier to observe and measure than are attitudes and other intangibles that are acquired by apprenticeship or experience but which cannot be described in concrete terms.
PROFESSIONALISM DEFINITION AS INTANGIBLES
Intangible aspects of professionalism can explain similar reactions of professionals to a situation without having to discuss or refer to a rule or code.
The intangibles could almost be called ‘trade secrets’ or practical wisdom (phronosis).
Intangibles can be considered under the Islamic legal principle of custom, ‘urf, with various formulations such as: what is known as customary has the force of law, al ‘aadat muhakkamat (Majallat Article No 36)[i][7] and what is known customarily is considered an agreed condition among the practitioners of a profession like trade, al ma’aruf ‘urfan ka al mashroot shartan (Majallat Article No. 43 and 44)[ii][8].
PROPFESSIONALISM AS SKILLS
Professionalism can also be defined as skills: A professional who is engaged in the same activities on a daily basis develops special skills.
In earlier times with limited knowledge and technology it was possible to list skills that a professional was supposed to have
It is not possible to list comprehensively skills of a professional today but the skill dimension is still assumed in attributes of professionalism such as such as ‘excellence’ because you cannot achieve excellence without being skilled
ABIM DEFINITION OF PROFESSIONALISM
Altruism
Accountability
Excellence
Duty
honor and integrity
Respect for others
ISLAMIC DIMENSIONS OF PROFESSIONALISM
Faith (iman)
Consciousness (taqwat)
Best character (ahsan al akhlaq),
Excellent performance (itqaan al ‘amal),
Strife toward perfection (ihsan),
Responsibility (amanat),
Self-accountability (muhasabat al nafs).
IMAN
Iman improves professionalism in two ways: holism and humility
Iman motivates the practice of holistic medicine emanating from the integrative doctrine of monotheism
Iman makes the physician more humble and less arrogant through the realization that he is an agent and the not the cause of cure; cure is in Allah’s pre-determination, qadar.
TAQWAT
Taqwat makes the physician conscious of his duties and meticulous in performance in the full knowledge that Allah is watching and knows all what is being done unlike human observers who cannot see hidden mistakes and bad intentions.
AKHLAQ
Akhlaq ensure the best human interaction between the physician on one hand and the patients and professional colleagues on the other hand manifesting as balance (tawazun), humility (tawadh’u), brotherhood (ukhuwwat), social respectability (muru’at),
Itqan and ihsan motivate the physician to improve his skills and knowledge to have the best outcome in his medical procedures.
The physician should take his work as a trust (amanat), involving: sincerity of intentions (ikhlas al niyyat); quality work (itqan & ihsan), and social responsibility (masuliyyat ijtima’iyyat).
Professionalism is part of the social contract involving responsibility of the professional to society[i][15].
TEACHING PROFESSIONALISM
Teaching of professionalism can be passive as apprenticeship.
Apprenticeship remains the best method because it is one to one and teaches practical wisdom and students learn from good role models.
The disadvantage of apprenticeship is that students may feel deficient in professionalism if they do not get teachers who are good role models
ISLAMIC WAY OF TEACHING PROFESSIONALISM
Traditional Muslim education based on a student being with the teacher all through the waking hours and being awarded permission to teach others, ijazah, at the end of a long apprenticeship
The system was not only about transferring knowledge but also transferred ethics, behavior, and attitudes by actual observation and interaction with a mentor.
The mentor also had ample time to observe the student and correct any deviations
The Qur’an describes this system in the education of Musa (PBUH) who travelled with the righteous man Khidhr and learned deep ethical lessons from him .
The prophetic teaching at Dar al Arqam: one to one, observation
Hadith literature: words, actions, and iqrar
ASSESSING PROFESSIONALISM
Due to its central role in medical practice, professionalism has been assessed among students and among physicians in practice.
Assessment enables us assess whether what students know is what the teachers taught.
Student assessment can be at the start, during, and at the end of the medical course.
Assessment at the start is useful to detect and start correcting unprofessional behaviors and attitudes.
Professional attitudes are set quite early in the student’s career by the ‘hidden curriculum’.
Early assessment enables discoveries of unprofessional attitudes and behaviors quite early.
Exposure to unprofessional behavior was least in the first year and highest in the fifth year.
Unprofessional behavior in student days is likely to resurface during internship and professional practice.
Students with low professionalism are more prone to errors.
Nijmegen Professional Scale developed in the Netherlands
Professional Mini Evaluation instrument developed in Canada.
Assessing knowledge, attitudes, and practice of professionalism;
Peer assessment of professionalism,
Assessment of student behaviors such as fulfilling duties
Analysis of student narratives on critical incidents
SUMMARY DAWA AND MEDICINE
The concept of dawa, its methods, and strategies
Role of medical professionals in dawa.
DEFINITION OF DAWA
Da’awah is conveying the message of Islam to Muslims and non-Muslims.
Da’awah is a communication process involving the caller, the called, the message, and behavioural change as a result of the message. The change could be accepting or practicing Islam better.
Included in da’awah are efforts at establishment of freedom of choice, of conscience and of religious practice.
Tauhid is the basis for all da’awa efforts, al tauhid asaas al da’awa
DAWA AND DYNAMISM
Da’awah is a very important mission for the ummah and was mentioned in many verses of the Qur’an.
Da’awah is an indication of dynamism. Islam is a missionary religion. Whenever Muslims are serious about their religion, they automatically find themselves engaged in da’awah.
Da’awah involves reminding. Human beings are not perfect. They forget and transgress and must be brought back to the straight path
OBLIGATION OF DAWA
Muslims are obliged to undertake da’awah, wujuub al da’awah. The obligation is collective, fardh kifayat, and is discharged if some people undertake it on behalf of the community.
Da’awah the vocation of professionals. Everybody is required to use any opportunity they get to undertake da’awah however small the effort may be.
Da’awah must be undertaken at all places and times. No occasion should be missed without making da’awah. All avenues must be used. You must knock on every door.
IMPACT OF DAWA
Da’awah has impact on the caller, the called, and the society at large.
The caller has to live up to certain expectations. You cannot give of what you do not have.
The called may be guided to the truth now or later.
The society at large will learn more about Islam and appreciate its beauty. This will consequently lead to decrease of hostility.
REWARDS OF DAWA
Every adult Muslim is obliged to do da’awah to the extent of ability. This is an ummatic duty.
The caller gets the reward for calling people to guidance equal to what they themselves get.
Accepting Islam is a favor for the called not the caller. As a caller you have a duty to convey the message. You get rewards for fulfilling the duty.
Guidance in the end is from Allah. He gives that gift to whomever he wants.
ATTRIBUTES OF THE CALLER
The caller must have the following personality characteristics: patience, wisdom, insight, iman, ‘Ilm, kindness, consideration, firmness, commitment, good personal relations, generosity, practicality, flexibility, and humility.
The most important attribute is commitment, ikhlaas.
The following characteristics make a caller more persuasive: Being perceived as honest, personal power, attractiveness, similarity to the called, being of the same gender as the called, expertise, and credibility.
DAWA AND SELF IMPROVEMENT
You do not have to be perfect to start da’awah. Da’awah will help you get better. Da’awah helps you improve yourself.
The challenge is that you have to live up to certain standards if you to call others. You are therefore more on your guard than others to avoid making any mistakes.
You have to check yourself continuously: self-criticism, self-evaluation, looking for mistakes in ideas, methods, and personal life.
All da’awah workers whether full-time or part-time must be trained. The training program must answer the following questions: Why train? Who trains? What is the content of training? The training program should be tailored to the local situation.
TARGETS OF DAWA
VARIOUS TARGETS: The called are the target of da’awah. Everybody is targeted, Muslims and non-Muslims, all races and nationalities, all social classes, and all parts of the world. Da’awah can be targeted at non-Muslim believers, non-Muslim non-believers (atheists and agnostics), or the general society.
MUSLIMS: Da’awah to Muslims involves calling them to practice Islam.
NON-MUSLIMS: Da’awah to non-Muslims exposes the truth and positives of Islam while correcting the disinformation by the enemies. It aims at returning them to the natural state of human beings, which is Islam. Da’awah to the general society involves propagating to the general public with the aim of making them aware or conscious of the presence of Islam.
SPECIAL POPULATIONS
Da’awah programs could target special populations such as women, youths, patients in hospitals, prisoners, students, laborers, and workers. They could also target special social classes such as artists and stars, aristocrats, middle class, professionals, and ordinary people.
THE MARGINALIZED
The marginalized and rejected members or classes of society are a special target group for da’awah because they are so susceptible. These include: criminals in prisons, drug addicts, the socially deprived, etc. They are looking for an alternative that will take them out of their sad situation.
DAWA STRATEGIES
Da’awah approaches could be defensive and reactive or aggressive and pro-active. It is better to take the initiative to take the message to the people rather than wait to defend it from attacks and distortions. When attacked, you should not take a defensive stance. Do not waste time in warding off ill-meant attacks and you fail to present the positives and strength of your message.
A phased approach must be used. The prophet started da’awah in secret. He called relatives first before addressing the public. He called Arabs before calling the rest of the world. The strategy is to gradually expand the circle of truth by defections from the circle of falsehood and ignorance.
Gradualism is needed in da’awah, al tadarruj fi al da’awa. Start by calling people to tauhid and to worship of the creator. Emphasize ‘aqiidah because it is the basis of the Ummah. People enter and leave the Ummah on the basis of ‘aqiidah. Present only the basics that are agreed on by everybody. Avoid any matters of differences or unclear issues.
Foot in the door approach is to present a weak point that will be accepted easily then present the stronger one later. The door in the foot strategy is to present a strong argument at the start and after it is rejected you present a weak one that is accepted as a concession.
Iman is not only intellectual conviction or acquisition of knowledge. It also includes emotional attachment and practical application. Da’awah will have a permanent impact only when it is followed by tarbiyyah.
Remember that influence by example is the most powerful tool; your character and behavior must be impeccable even in the face of hostile attacks. You must mix and socialize with the people called.
WISDOM OF DAWA
Wisdom in da’awah, al hikmat fi al da’awah, is always effective. You must be wise in your approach. Do not antagonize or provoke people. Your arguments should be polite.
You should aim at convincing and not defeating people and making them feel bad about themselves.
There is a human tendency to be argumentative. Some people will argue for the sake of argument. Watch out for such people. They will waste your time and you will get nowhere with them.
Do not attack or criticize. Provide the alternative. Always concentrate on presenting the truth. Truth automatically displaces falsehood. You need not attack the falsehood in all cases.
Attack provokes counterattacks and may become a psychological barrier to the conveyance of the message.
DIRECT DAWA METHODS
Da’awah may be by direct or indirect approach. It may be by personal or remote contact. In our experience the most effective methods are those that involve personal contact.
Personal contact methods may be one-to-one, one-to-many, many-to-one, and many-to-many. Direct contact and oral discussion are effective because of the personal rapport and immediate feedback.
Occasions for direct contact for purposes of da’awah include: the street, the work place, the mosque, the market, the theater, and public celebrations.
Storytellers and griots in rural areas are a resource that has not been used.
Public adhan over the loudspeaker has an impact by daily reminding listeners, Muslim and non-Muslim about Allah.
The methods of da’awah used in direct contact include: good personal relations to influence by example, teaching and tarbiyyat, preaching (wa'dh, khutbat), lectures, seminars, conferences, debates, discussions, providing social services, material assistance to the muallafat qulubuhum, treating people with justice, telling people to do good and forbidding the bad, telling stories and proverbs, and poetry.
It is better to start da’awah with people you already know or with whom you have some sort of relationship. This is easier than complete strangers.
Preaching, maw’idhat, is an effective method of da’awah but should not be misused. Do not preach too much to people. Avoid being a nuisance. Do not impose yourself on people. Make sure that when talking to them they are indeed interested. It is better to talk to people briefly but repeat the process than bore them with a long presentation.
INDIRECT DAWA METHODS
Indirect/remote contacts include: letters (personal and circulars), books, newsletters, newspapers, flyers, the public library, artistic works, cartoons, films and videos, radio and TV, audio cassettes.
Try to talk to people in the language they understand. By language is meant not only English, French, or German. You must use idioms, examples, expressions, and concepts that they understand.
You must gear your communication to the cultural and educational background of the called.
The biggest mistake is to talk to everybody alike. There are differences that must be respected.
TYPES AND STAGES OF CONVERSION
Conversion can be intellectual, emotional or both.
Everybody comes to Islam through a different sequence. Some people start by reading and getting intellectually convinced. Then they make contact with Muslims and get emotionally and cultural involved.
Some people live with Muslims, see their behavior and get attracted to their religion and way of life. They accept Islam and study to get the intellectual dimension.
Calibrate the content and method of the message to the appropriate stage of conversion.
Philosophical understanding of the faith is not a condition for conversion and is not an obligation. It will come with time.
Moral transformation is individual. The aim should be to raise the level of the individual. The message should therefore be individualized and customized as much as possible to the intellectual and emotional state of the target.
The message conveyed is simple and direct; keep it so. Do not complicate it at all.
Ideas are powerful and are infectious. True ideas are the most powerful. We have to continue propagating even if there are no tangible results. People are always infected but the manifestation of changed attitudes, convictions, and beliefs may be delayed.
DYNAMICS OF DAWA
Da’awah has its own dynamics. It is very difficult at the beginning. Once you start getting some success with some people accepting the call, things get easier.
Success leads to more success. People tend to get convinced if they see others like themselves being convinced.
PLANNING OF DAWA
Planning da’awah is very important in the complicated society of today.
Planning basically helps use available resources in the most efficient way.
The main elements that a da’awah plan covers are: the caller, the called, the time dimension, resources (money, material), and program control.
FUNDING OF DAWA
Da’awah requires funding. It however can never succeed if it is fully professionalized.
Volunteers will always be needed to do the legwork. Blessings are in the motivation and enthusiasm of the volunteers.
COORDINATION OF DAWA
Da’awah must be coordinated to avoid unnecessary duplication and competition.
Individual initiative should never be curtailed or suppressed in the name of unity and coordination.
What you should aim at is unity of purpose and not necessarily one da’awah organization.
EVALUATION OF DAWA
Da’awah programs must be evaluated for effectiveness; the results of evaluation being used to improve the program.
Lack of immediate success should not be a reason for giving up. Continue and persevere.
Most evaluation is that of the process. Outcome evaluation very difficult and unreliable in da’awah. Results of da’awah are long-term and are difficult to quantify.
Never forget to pray to Allah to guide the called. You may do all what is humanly possible and not succeed. It is Allah who guides.
Opposition should never tempt you to consider a violent approach. Da’awah is a peaceful process that targets the hearts of men and not their bodies.
DAWA IN THE MEDICAL SETTING
Medics and paramedics have unique opportunities for dawa that other professions do not have. This is because of their intimate contact with patients.
The patients are very receptive to dawa because they are dependent, anxious, and think of death and the hereafter.
The patients are removed from the daily chores of life and actually have time to think about their present life and their destiny.
The healthcare worker makes dawa by example. In his behavior and dealing with the patient he must display the highest standards of conduct. This will open the heart of the patient to ask about Islam and seek to know more.
The patient will be curious about the motivation for the good conduct. The patient discovers teachings of Islam can motivate health workers to be kind, empathetic, caring, efficient, and helpful. This is then the beginning of a long journey of searching for Islam.
The healthcare may help in the search and follow-up or may leave that to other dawa workers outside the hospital. The essence of this is that the health worker can be a catalyst for the dawa process that may end in conversion to Islam.
DAWA BY THE ETIQUETTE OF THE BEDSIDE VISIT
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 dhikr.
Caregivers should seek permission, idhn, before getting to the patient. They should not engage in secret conversations that do not involve the patient.
GENERAL ETIQUETTE OF THE HEALTHCARE WORKER
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, husn al dhann, and avoid evil or obscene words.
They must observe the rules of lowering the gaze, ghadh al basar, and khalwat.
Caregivers must have an attitude of humbleness, tawadhu'u.
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 qadar can only be changed by dua. They can make ruqya for the patients by reciting the two mu’awadhatain or any other verses of the Qur’an.
They must seek permission, isti' dhaan, 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.
DEALING WITH THE FAMILY IS DAWA
Visits by the family fulfill the social obligation of joining the kindred and should be encouraged.
The family are honored guests of the hospital with all the shari’at 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.
MEDICAL SERVICES AS DAWA
Medicine should be taught as a social service with the human dimension dominating the biomedical dimension.
Medicine should be practiced as of mutual social support.
Medical education should prepare the future physician to provide service to the community. This will require skills of understanding and responding to community needs that can be acquired by spending part of the training period in a community setting away from the high technology hospital environment.
MEDICAL PROFESSIONAL’S LEADERSHIP IS DAWA
The medical school curriculum and experience should be a lesson in social responsibility and leadership.
The best physician should be a social activist who goes into society and gives leadership in solving underlying social causes of ill-health.
The physician as a respected opinion leader with close contact with the patients must be a model for others in moral values, attitudes, akhlaq, and thoughts.
He must give leadership in preventing or solving ethical issues arising out of modern biotechnology. He must understand the medical, legal, and ethical issue involved and explain them to the patients and their families so that they can form an informed decision. He should also provide leadership in advocating for the less privileged and advocacy for human rights.