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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0510-PATIENT EDUCATION WITH REFERENCE TO THE BREAST LUMP CASE

By Professor Omar Hasan Kasule Sr.

INTRODUCTION

There are several conceptual issues mostly related to religion that must be cleared up before education can be effective in a patient presenting with a breast lump. Among these issues are: the role of qadar / pre-destination / pre-determination in disease causation and cure, and traditional vs scientific medicine. It is also necessary to address patient concerns about examination and treatment by a caregiver of the opposite gender, We need to decide the extent of disclosure and how we male such disclosure. We also need to consider culturally-sensitive methods of patient education to be able to get behavioural change.

 

MISUNDERSTANDING OF QADAR / TAQDIR

Patients may refuse to seek medical care arguing that it is God’s will and that they should not interfere with it. This is a misunderstanding of qadar (pre-determination). Human illness is part of qadar. Medical treatment is not denial of or attempting to reverse qadar. Both the disease and its treatment are part of God’s all-embracing qadar. Humans in their limited knowledge cannot distinguish between curable and incurable disease. They therefore must play safe by treating all diseases to the best of their ability being fully aware that this is an attempt and leave the rest to God. God alone determines life and death. No human can give life or take it away. The human can be involved as an agent but not as a cause of life or death. Correct understanding of qadar requires distinguishing tawakkul that is good from tawaakul that is bad. Tawakkul in relying on God after taking all the necessary measures to achieve an objective following the laws of causality. Tawaakul is giving up all effort and just wait for things to happen.

 

CAUSES OF DISEASE

Every phenomenon in life has an immediate cause, sabab, that humans can search for and find. However behind all these causes is the power and majesty of God who alone is the source of all causes, musabbib al asbaab. When all the factors that produce a certain pathological condition exist, we say that there is a sufficient cause of disease. There are empirical factors that must operate for a certain pathological condition to occur. These are referred to as necessary causes. Denying their existence is denying the cardinal principle of God’s Laws in the Physical World, sunan Allah fi al kawn, and is akin to superstitious belief. Human diseases, like the human organism, are complicated and usually several factors are involved in their causation. Humans may know some of the factors and ignore others. It is not necessary to know all the factors in order to treat a disease. Since the factors usually act in sequence, knowledge of only one may be sufficient to interrupt the causal pathway.

 

The causation, progression, and resolution of disease are in the hands of God and are part of qadar. It is God’s pre-determination that a person falls sick. Humans try to understand disease processes in order to reverse them. This is not contradicting or opposing God’s will. All what a physician does is with God’s permission and is therefore part of pre-determination. Treatment and prevention of disease are not against qadar but are subsumed under the principle that qadar can reverse another qadar, radd al qadar bi al qadar. In the end all cure is from Allah and not the human[i].

 

CURE OF DISEASE

Every disease has a treatment. God did not reveal any disease without also creating its cure. Humans are encouraged to seek treatment. Some people may know the cure and others may ignore it but it nevertheless exists. The scriptures described cure of prophet Job’s disease[ii] and how Jesus cured chronic diseases[iii]. Humans try, but it is God who cures[iv]. Disease treatment is part of qadar[v]. Seeking treatment does not contradict qadar or tawakkul. Disease treatment is part of qadr and is reversal of qadar by another qadar , rad al qadr bi al qadr.

 

SHIRK and SUPERSTITION IN SEEKING CURE

Shirk arises when humans seek and expect cure of disease from anything other than God. Forbidden shirk practices in disease treatment include: talismans[vi], amulets[vii], fortune telling[viii], divination[ix], astrology[x], sorcery[xi], and asking cure from humans called saints by visiting their graves. Other superstitious practices usually associated with shirk are: claiming knowledge of the unseen and claiming supernatural powers by any human. Many people with disease conditions resort to shirk practices due to misguidance by shaitan. These practices nullify belief in monotheism, aqidat al tauhid, because they attribute disease and its cure to other than God. They also distract from seeking true treatment based on rational scientific medicine.

Jinn possess limited power that is used to misguide and give credibility to shirk and superstition. The jinn do not know the unseen[xii]. A good believer should not be involved with jinns and should ask Allah for protection against them[xiii].

Some forms of dream interpretation, tafsir al ahlam, are forms of shirk. Only God knows for sure the correct interpretation of dreams. Limited ability to interpret dreams was given to some prophets[xiv]. Other humans do not this ability. Therefore dreams of ordinary humans should have no role in the diagnosis, treatment and prognosis of disease.

 

MODALITIES OF TREATMENT

Among spiritual approaches to disease management is use of supplication, dua, from the Qur’an[xv] and hadith as ruqiy.The formulas for ruqy reported from the prophetare surat al fatihat, surat al falaq, surat al naas, ayat al kursi, and various supplications by the prophet, dua ma’athurat. Other spiritual cures are reciting the Qur’an[xvi], asking God for protection, and physical prayer, salat[xvii].

Among physical approaches to disease management are: diet, natural agents (chemical, animal and plant products), manufactured chemical agents, surgery, and physical treatment like heat. Physical approaches can reverse disease pathology, mitigate its effects or just stop farther progression. All therapeutic agents and procedures are allowed unless they contravene a specific provision of the law. This provides a wide scope for the practice of medicine. Medicine is bad and is forbidden[xviii] if it causes more harm than benefit. Haram material is not allowed as medicine except in special circumstances where the legal principle of necessity, dharurat, applies. The side effects of medication must be considered alongside the benefits. Choice of what treatment modality to use involves careful weighing of benefits and possible harm or injury. Priority is given to preventing harm over accruing a benefit.

There should no dichotomy between spiritual and physical modalities of treatment. Both approaches should be used for the same condition; they are complementary. Each cures the disease each using a different pathway. There is no contradiction but there is always synergy. It is a mistake to use one and reject the other.

 

HISTORY TAKING AND PHYSICAL EXAMINATION

Patient consent is necessary for history taking otherwise it is considered trespassing on privacy and spying. History taking provides an opportunity to discuss social and psychological issues relating to the disease. Physical clinical examination also requires informed consent. Examination by a caregiver of the opposite gender requires special consideration. It is always preferable that physicians of the same gender carry out the examination. A physician of the opposite gender can be used only if a situation of necessity arises. A chaperone must be present. Examination is limited to what is necessary. The results of laboratory investigations have the same requirements for confidentiality as history and clinical examination. The results of radiological investigations are confidential. Images that show the shape of the body parts can be considered showing nakedness, ‘awrat, and should not be seen except by authorized people only and for specific purposes. Invasive investigations carry a higher risk to the patient; their benefits should be carefully weighed against the benefits. These investigations should be carried out only if there is a clear necessity, dharuurat.

 

DISCLOSURE AND TRUTHFULNESS

As part of the professional contract between the physician and the patient, the physician must tell the whole truth. Patients have the right to know the risks and benefits of medical procedure in order for them to make an autonomous informed consent. Deception violates fidelity. If disclosure will cause harm it is not obligatory. Partial disclosure and white or technical lies are permissible under necessity. Disclosure to the family and other professionals is allowed if it is necessary for treatment purposes. Physicians must use their judgment in disclosure of bad news to the patient.

 

THE HEALTH EDUCATOR

The educator must have the following personality characteristics: patience, wisdom, insight, iman, ‘Ilm, kindness, consideration, firmness, commitment, good personal relations, generosity, practicality, flexibility, humility, The following characteristics make an educator more persuasive: being perceived as honest, personal power, attractiveness, likableness, similarity to the called, being of the same gender as the called, expertise, and credibility.

 

STRATEGIES AND METHODS

Success depends on phasing, gradualism, and influence by example. Education requires a wise, polite, non-antagonist, non-critical approach presentation of the health message. Education may be direct or indirect, personal or impersonal. Personal contact is the most effective approach. The message should be individualized and customized. It should be simple and direct.


[i] (26:80)

[ii] (21:83-84 & 38:41-44)

[iii] (3:49 & 5:11)

[iv] (21:83-84 & 38:41-42)

[v] (Tirmidhi K26 B21)

[vi] (Muslim K39 H121)

[vii] (5:3 & 5:90)

[viii] (Muslim K39 H121)

[ix] (Bukhari K76 B17)

[x] (Ibn Majah K23 B28)

[xi] (Bukhari K76 B17)

[xii] (15:17-18 & 72:8)

[xiii] (3:36 & 114:1-6)

[xiv] (12:6 &  12:100-101)

[xv]  (17:82)

[xvi] (Ibn Majah K31 B28)

[xvii] (Ibn Majah K31 B10)

[xviii]  (Tirmidhi K26 B7)

Professor Omar Hasan Kasule, Sr. October 12, 2005