Transcript 15professionalism in..

PROFESSIONALISM IN A
CULTURAL CONTEXT
Objectives
Define the following terms :
race, ethnicity and culture
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Describe the basis for understanding the
cultural diffrences
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Describe the importance of understanding of
cultural differences in professionalism
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Describe the different consultation models
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List three (3) fundamental principles of
medical professionalism
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Give three (3) charecteristics of
professionalism in a cultural context.
What do you understand by the word
Professionalism in relation to culture
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Think for a little while, then
Describe it in a few sentences.
Do you agree
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Professionalism is culture-sensitive
Cultural Diversity
Why Now?
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Increased recognition, interest
and respect for diverse societal
values. Why?
What exactly do we mean
by race, ethnicity and
culture?
 Race
–Genetically there is only one race,
which is the human race. Society makes
judgments about the varieties of biological
characteristics. Eventually, biological
characteristics are seen as socially
constructed which often leads to
stereotyping.
What exactly do we
mean by race, ethnicity
and culture?
 Ethnicity
- An individual’s
identification with a particular
cultural group to which they are
biologically related.
What exactly do we
mean by race, ethnicity
and culture?
 Culture
- A set of beliefs, values
and traditions that are socially
transmitted from one generation
to another. It defines a group’s
norm’s or community’s identity.
Cultural Differences
MAY INCLUDE:
Value the family over the individual.
 Engage and expect the family’s support in
their self-care.
 Value the institution’s that are sensitive to
their cultural needs.
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Cultural Differences
 Liberal
visiting hours and an un-limited number of
visitors (Family based care).
 Incorporation of religious beliefs and cultural
traditions in tandem with Western medicine.
SO........................
 Should be evaluated carefully to improve healthcare
outcomes and prevent:
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Misunderstandings
Stereotyping
Barriers
Conflict
Why do values matter?
Attention to our values helps us;
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Become more self-aware.
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Make ethical decisions.
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Understanding one's own core values is integral to becoming selfaware. Self-awareness helps us understand how people perceive us,
it enables us to identify the personal qualities that we would like to
change.
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Values influence our choices, but our choices also influence our
values.
Medical professionalism encompasses all of
the aspects of the higher attributes of being a
physician and a healer.
 These attributes, however, are not universal;
cultural differences exist (Cruess et al. 2010).
 It appears that the ‘difference’ is greater when
the context shares an ‘eastern culture’ than a
‘western’ culture.
 This confirms the existence of cultural
variations and context specificity of
professionalism.
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CULTURAL CONTEXT IN UNDERGRADUaTE MEDICAL EDUCATION
CURRICULUM
• The goal of the curriculum is to prepare
students to care for patients from diverse
social and cultural backgrounds including
racial, ethnic and gender biases.
• The foundation of cross cultural care is based
in
the
attitude
central
to
medical
professionalism.
FOCUSING ON KNOWLEDGE IN
CULTURAL CONTEXT
1.
It is important for a medical student or post graduate
trainee to learn about the surrounding community in
which he/she practices or trains.
e.g. Socio economic status, patterns of housing
nutritional habits, healing practices and disease
incidence and prevalence.
2.
The knowledge taught has specific evidence based
impact on health care delivery.
e.g. How Ramadan fasting affects Muslims who are
diabetic.
Professionalism in Different Cultural
Contexts
Culture: ‘‘An integrated pattern of learned
core values, beliefs, norms, behaviors and
customs that are shared and transmitted by a
specific group of people.
 Some aspects of culture, such as food,
clothing, modes of production and behaviors,
are visible.
 Major aspects of culture, such as values,
gender role definitions, health beliefs and
worldview, are not visible.’’

Professionalism in Different
Cultural Contexts
Recognizing the role of culture in health
means an acknowledgment of the
importance of shared values, perceptions,
and beliefs related to health.
 Culture is directly related to health
promotion, disease prevention, early
detection, access to health care, trust and
compliance
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CULTURAL INFLUENCES ON
MEDICAL PROFESSIONALISM
Characteristics of Professionalism

Competency
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Responsibility
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Attitude

Conduct on the job
Professionalism Vs Professional
behaviour
ATTITUDES CENTRAL TO MEDICAL
PROFESSIONALISM IN CULTURAL
CONTEXT
•
Humility
•
Empathy
•
Respect
•
Sensitivity
•
Curiosity and
•
Awareness of all outside influences including
cultural on patients health
Professionalism in Different
Cultural Contexts
Respect implies that each individual has a
right to receive respect according to his or
her own personal, individual, family, and
socio-historical perspective.
 We must learn to demonstrate our respect
to individual patients in ways that each
person will receive or perceive as being
respectful.

MEDICAL PROFESSIONALISM
Three fundamental principles:
1.
Patient welfare
2.
Patient autonomy
3.
Social justice
PATIENT WELFARE INCLUDING
AUTONOMY
1.
2.
3.
4.
5.
6.
7.
Professional competence
Honesty with patients -- integrity
Patient confidentiality
Caring attitude
Scientific knowledge
Maintaining trust
Setting and maintaining professional
standards.
SOCIAL JUSTICE
1.
A just distribution of finite
resources
2.
Managing conflict of interest
3.
Improving quality and access to
care
4.
Respect for colleagues
Professionalism in Different
Cultural Contexts
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Help students and others to incorporate
elements of cultural competence into their
practice.
FOCUSING ON SKILLS IN
CULTURAL CONTEXT
With individual patients as teachers, learners
should be encouraged to adjust their practice
styles accordingly to meet their specific needs.
It is crucial to understand health beliefs of those
who come from different cultures or have
different health care experiences.
Professionalism in Different
Cultural Contexts
Cultural Competency
 Respect
 Assess/Affirm
 Sensitivity/ Self Awareness
 Humility
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Professionalism in Different
Cultural Contexts
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Cultural Competency: The importance of
shared values, perceptions, and connections
in the experience of health, health care, and
the interaction between patient and
professional.
Respect: Understanding that demonstrations
of respect are more important than gestures
of affection or shallow intimacy, and finding
ways to learn how to demonstrate respect in
various cultural contexts.
Professionalism in Different
Cultural Contexts
Assess: Understanding that there are tremendous
‘‘within-group differences,’’ ask about cultural
identity, health preferences, beliefs, and
understanding of health conditions. Assess
language competency, acculturation-level, and
health literacy to meet the individual’s needs.
 Affirm: Recognizing each individual as the world’s
expert on his or her own experience, being ready
to listen and to affirm that experience. Re-framing
cultural differences, by identifying the positive
values behind behaviors we perceive as
‘‘different.’’
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Professionalism in Different
Cultural Contexts
Sensitivity: Developing an awareness of
specific issues within each culture that
might cause offence, or lead to a
breakdown in trust and communication
between patient and professional.
 Self-Awareness: Becoming aware of our
own cultural norms, values, and ‘‘hotbutton’’ issues that lead us to mis-judge or
miscommunicate with others.
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Professionalism in Different
Cultural Contexts
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Humility: Recognizing that none of us ever
fully attains ‘‘cultural competence,’’ but
instead making a commitment to a lifetime
of learning, of peeling back layers of the
onion of our own perceptions and biases,
being quick to apologize and accept
responsibility for cultural mis-steps, and
embracing the adventure of learning from
others’ first-hand accounts of their own
experience.
Professionalism in Different
Cultural Contexts
Listen
 Explain
 Acknowledge
 Recommend
 Negotiate
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Professionalism in Different
Cultural Contexts
Listen with sympathy and understanding
to the patient’s perception of the problem
 Explain your perceptions of the problem
 Acknowledge and discuss the differences
and similarities
 Recommend treatment
 Negotiate agreement
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Professionalism in Different
Cultural Contexts
Partnership
 Empathy
 Apology
 Respect
 Legitimization
 Support
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Professionalism in Different
Cultural Contexts
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Partnership: Working with the patient to accomplish a shared
outcome
Empathy: Recognizing and comprehending another’s feelings
or experience
Apology: Being willing to acknowledge or express regret for
contributing to a patient’s discomfort, distress, or ill feelings
Respect: Non-judgmental acceptance of each patient as a
unique individual; treating others as you would have them
treat you.
Legitimization: Accepting patient’s feelings or reactions
regardless of whether or not you agree with those
perceptions.
Support: Expressing willingness to care and be helpful to the
patient however you can.
Professionalism in Different
Cultural Contexts
What do you call your problem? What
name does it have?
 What do you think caused your problem?
 Why do you think it started when it did?
 What does your sickness do to you? How
does it work?
 How severe is it? Will it have a short or
long course?
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Professionalism in Different
Cultural Contexts
What do you fear most about your
disorder?
 What are the chief problems that your
sickness has caused for you?
 What kind of treatment do you think you
should receive?
 What are the most important results you
hope to receive from the treatment?
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THE CENTRALITY OF PATIENT
PHYSICIAN RELATIONSHIP TO
MEDICAL PROFESSIONALISM
Four Possible Consultation Models
1.
2.
3.
4.
Physician
Physician
Physician
Physician
as
as
as
as
parent, imam or priest (paternalistic)
a mentor
a technician or contractor
a friend or Counselor
CULTURAL INFLUENCES ON
MEDICAL PROFESSIONALISM
Dependent on community’s social values and
moral norms
PATERNALISTIC MODEL
CULTURAL INFLUENCES ON
MEDICAL PROFESSIONALISM
PHYSICIAN AS A PARENT
PATERNALISTIC MODEL:
Physicians are in the best position to judge
what is best for their patients. In a strong form
of this, physicians authoritatively order patients
to assent (with coercion if necessary).
Culturally applicable in Chinese culture and
partially in other Far East and South Asian
cultures.
CULTURAL INFLUENCES
PHYSICIAN AS A MENTOR
DELIBERATIVE MODEL
Physician objectively knows and prioritizes
patient’s personal and medical values.
The physician mentor’s grip on decision making
is more relaxed than the physician / parent
model but autonomy- conscious patients find it
unsatisfactory.
Culturally this is an option for some of the
patients in Eastern countries
CULTURAL INFLUENCES
PHYSICIANS AS TECHNICIANS
INFORMATIVE
ENGINEERING MODEL
Physicians only provide value
neutral medical information
and leaving patients to make
decisions
independently
based on personal values
(total patient auto-nomy).
Cont’d
CULTURAL INFLUENCES
Physicians treat diseases rather than
patients and sick persons are
“Consumers”.
Culturally applicable To certain
sections of Western and relatively
less eastern popu-lation.
Cont’d
CULTURAL INFLUENCES
Contd
PHYSICIANS AS FRIENDS OR COUNSELLORS
INTERPRETIVE/ COLLEGIAL MODEL
• Physician’s medical facts and patients personal
values contribute to balanced medical decisionmaking.
• This approach upholds patient autonomy without
undermining the physician’s duty of beneficence.
• Shared decision making culturally popular in the
West, increasingly accepted in the East .
CULTURAL INFLUENCES
While providing professional care physician must
not impose his / her view on a patient’s--• Life style, culture, beliefs, race
• Sex, age / sexuality
• Social status / economic worth
Physicians must be prepared to explain and justify
his / her actions and decisions
Contd
CULTURAL INFLUENCES
CONFIDENTIALITY
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Confidentiality concept may not
be the same in the East as in
the West. However its
principles are applicable in
most settings.
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Physicians must be honest and
trust worthy
Contd
CULTURAL ISSUES
Contd
SIGNING CERTIFICATES AND OTHER DOCUMENTS
•
One must not sign certificates or documents
which one believes to be false or misleading.
•
•
Eg: inappropriate sick leave forms
Same principles apply with references.
CULTURAL ISSUES
Contd
ADVERTISING
•
Physicians must not exploit patient’s vulnerability or lack of medical knowledge.
•
Only factual information should be provided.
CULTURAL ISSUES
Contd
RESEARCH
•
Research should not be contrary to the patient’s interest e.g.
exploitation of developing countries patients.
•
Research protocol should be approved by a research ethics
committee.
•
This committee may be non existent in many settings.
•
Your conduct in the research must not be influenced by payments or gifts.
•
Record your research results truthfully
SPECIAL CULTURAL ISSUES
CONFLICT OF INTEREST
•
Patients best interest–lack of appropriate referral system may have
adverse effects on patient care.
•
Inducements / incentives for referrals
Contd
SPECIAL CULTURAL ISSUES IN PROFESSIONAL
CARE IN Islamic REGION
CONSULTATION / CONFIDENTIALITY
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Insistence on eye contact?
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Uncovering of face in some females
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Undressing of female patients?
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Sharing of confidential information with spouses, relatives?
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History taking of female adults from parents or husbands?
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Giving information to patients in a way they can understand
SPECIAL CULTURAL ISSUES
•
The way you prescribe for, refer or
follow-up patients should not be
affected if you have financial or
commercial interests in organizations
providing health care
•
Honesty is a must in financial and
commercial matters relating to
physician’s work
Contd
SPECIAL CULTURAL ISSUES
Contd
ACCEPTING GIFTS OR OTHER INDUCEMENTS
 You should not ask for or accept any material
rewards, except those of insignificant value from
representatives of pharmaceutical companies.
 Help with conferences and educational activities
may be acceptable
Professionalism in Different
Cultural Contexts
CONCLUSION
Patients are entitled to good standards of
professional practice and care in all cultural settings.
The essential elements of this medical professionalism are:
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Professional competence
Good relationship with patients and colleagues
Observance of professional ethical obligations
Medical teachers should be a role model’ in
application of these essentials
Summary

‘‘An integrated pattern of learned core values,
beliefs, norms, behaviors and customs that are
shared and transmitted by a specific group of
people.

Some aspects of culture, such as food, clothing,
modes of production and behaviors, are visible.

Major aspects of culture, such as values, gender
role definitions, health beliefs and worldview, are
not visible.’’
Summary.......Cont

Recognizing the role of culture in health means
an acknowledgment of the importance of
shared values, perceptions, and beliefs related
to health.

Culture is directly related to health promotion,
disease prevention, early detection, access to
health care, trust and compliance
Summary............Cont

Respect implies that each individual has a right
to receive respect according to his or her own
personal, individual, family, and socio-historical
perspective.

We must learn to demonstrate our respect to
individual patients in ways that each person will
receive or perceive as being respectful.