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ISLAMIC MEDICAL EDUCATION RESOURCES-03

0508-ETIQUETTE (ADAB), OF THE MEDICAL STUDENT WITH PATIENTS and FAMILIES

By Professor Omar Hasan Kasule Sr.

Learning Objectives

Proper etiquette (adab) with patients and their families

 

Key Words and Terms


  • Appearance of the student
  • Mannerisms of the student

        Bed-side visits

        Obligation to visit the patient

        Prophet’s visiting a patient

        Greeting the  patient

        Dua for the patient

        Talking with the patient

        Etiquette of the patient

  • Etiquette of sneezing
  • Health professional’s etiquette
  • Duties and rights
  • Respecting rights of the patient
  • Advance directives on treatment
  • Privacy
  • Access to information

        Informed consent

  • Prevention of contagion
  • Emotional involvement

        Spiritual approach to care

        Role of dua in medical care

        Role of ruqya

        Medical procedures

        Resuscitation

        Supportive care

  • Interaction between genders
  • Medical necessity, dharuurat

        Students of the opposite gender

        Colleagues of opposite gender

        Patients of the opposite gender

        Rights of visitation for the family


 

UNIT OUTLINE

BED-SIDE VISITS

A. Obligation To Visit The Patient, Wujuub Iyadat Al Mariidh

B. Prophet’s Visiting A Patient

C. Greeting The  Patient

D. Dua For The Patient

E. Talking With The Patient

 

ETIQUETTE OF THE PATIENT

A. Gratitude

B. Patience

C. Dua

D. Activities of Daily Living

E. Emotions

 

ETIQUETTE OF THE HEALTH PROFESSIONAL

A. Rights of the Patient

B. Appearance and Mannerisms of the Health professional

C. Spiritual Approach to Care

D. Medical Intervention

E. Supportive Care

 

ETIQUETTE OF INTERACTION BETWEEN GENDERS

A. Over-View & Summary

B. The Principle of Necessity in a Medical Situation

C. Students of the Opposite Gender

D. Colleagues of Opposite Gender

E. Patients of the Opposite Gender

 

DEALING WITH THE FAMILY

A. Rights of Visitation for the Family

B. Support

C. Reassurance:

D. Involvement

E. What Not To Do


UNIT SYNOPSIS

BED-SIDE VISITS

The health professional-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. Health professionals should seek permission, idhn, before getting to the patient. They should not engage in secret conversations that do not involve the patient.

 

ETIQUETTE OF THE PATIENT

The patient should express gratitude to the health professionals even if there is no physical improvement. Patient complaints should be for drawing attention to problems that need attention and not criticizing health professionals. The patient should be patient because illness is kaffaarat and Allah rewards those who surrender and persevere. The patient should make dua for himself, health professionals, visitors, and others because the dua of the patient has a special position with Allah. When a patient sneezes he should praise Allah and the mouth to avoid spread of infections. It is obligatory for the attendants to respond to the sneezer. The patient should try his best to eat and drink although the appetite may be low. The health professionals cannot 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 from Allah. 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.

 

ETIQUETTE OF THE HEALTH PROFESSIONAL

The health professional should respect the rights of the patient regarding advance directives on treatment, privacy, access to information, informed consent, and protection from nosocomial infections. Health professionals 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. Health professionals 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 health professional must never promise cure or improvement. Every action of the health professional must be preceded by basmalah. Everything should be predicated with the formula inshallah, if Allah wishes. The health professionals 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. Health professionals must reassure the patients not to give up hope. Measures should be taken to prevent nosocomial infections.

 

ETIQUETTE OF INTERACTION BETWEEN GENDERS

Both the health professional and patient must cover awrat as much as possible. However, the rules of covering are relaxed because of the necessity, dharurat, of medical examination and treatment. The benefit, maslahat, of medical care takes precedence over preventing the harm inherent in uncovering awrat. When it is necessary to uncover awrat, 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 health professionals should be sensitive to the psychological stress of patients, including children, when their awrat is uncovered. They should seek permission from the patient before they uncover their awrat. Health professionals who have never been patients may not realize the depth of the embarrassment of being naked in front of others. 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: learning clinical skills by examining other students; Operation theatre. Medical personnel of opposite genders should wear gender-specific garments during surgical operations because Islam frowns on any attempt to look like the opposite gender. Shari’at 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 health professional of the same gender. In conditions of necessity a health professional of the opposite gender can be used and may have to look at the ‘awrat or touch a patient. The conditions that are accepted as constituting dharuurat are: skills and availability. The preference between a Muslim of opposite gender vs non-Muslim of same gender depends on the local situation.

 

DEALING WITH THE FAMILY

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 health professional 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. Health professionals must be careful not to be involved in family conflicts that arise from the stresses of illness.

 

DISCUSSION QUESTIONS

BED-SIDE VISITS

1.      Describe the obligation of visiting the sick

2.      Describe the Islamic etiquette of visiting the sick

3.      Describe how the health professional-patient interaction is a dual, professional and social.

4.      Explain how the ward rounds fulfill the social obligations of visiting the sick.

5.      Explain why the human relation has priority over the professional

6.      Give examples from siirah on etiquette of visiting the sick by the prophet

7.      Describe the etiquette of greeting the patient

8.      Describe the manner of dua for the patient by the health professional 

9.      Describe the Islamic etiquette of talking to the patient

 

ETIQUETTE OF THE PATIENT

  1. Describe recommendations on gratitude and complaints by patients
  2. Describe Islamic teachings on patience by the patient
  3. Describe dua by the patient for himself and others
  4. Describe the Islamic etiquette of sneezing and response to the sneezer
  5. Describe the Islamic etiquette on drinking and eating of the patient
  6. Describe Islamic guidelines on hope and not wishing for death
  7. How should the patient deal with anger

 

ETIQUETTE OF THE HEALTH PROFESSIONAL

  1. List and describe duties of a health professional as a Muslim
  2. List and describe duties of a health professional as a professional
  3. List and describe the rights of the health professional
  4. Give guidelines on respecting rights of the patient
  5. Give guidelines on respecting the patient’s advance directives on treatment
  6. How can a health professional respect the patient’s privacy
  7. How can a health professional can respect the patient’s right of access to information

24.  Summarize legal guidelines on informed consent

  1. Summarize guidelines of preventing nosocomial infections
  2. Summarize guidelines on appearance of a health professional
  3. Summarize guidelines on the mannerisms of a health professional
  4. Give guidelines on the emotional involvement of  health professional with a patient

29.  Explain the relation between dua and qadar in cure of disease

30.  Explain how the Qur’an is the best medicine

31.  Discuss dua for the patient by the health professional

32.  Explain dua for the health professional by the patient

33.  Define ruqya and the regulations related to it

34.  Why should health professional seek permission before approaching the patient

35.  Discuss the importance of respecting the privacy of the patient

36.  Describe professional, competent, and considerate care.

37.  Describe the legal guidelines on balancing risks and benefits

38.  Explain why the health professional should never promise cure

39.  Explain the importance of basmalah before any medical procedure

40.  Discuss the importance of saying inshallah in medical care

41.  Summarize legal guidelines on instituting resuscitative measures

42.  List and describe various forms of supportive care for patients

43.  Describe Islamic guidelines on patient hygiene

44.  Summarize Islamic guidelines on patient nutrition

45.  Describe guidelines on fever management

46.  Summarize guidelines on managing pain

  1. Summarize guidelines on controlling infections

 

ETIQUETTE OF INTERACTION BETWEEN GENDERS

  1. Describe the dharuurat of uncovering ;awrat for medical purposes
  2. Summarize legal guidelines on uncovering ‘awrat during medical procedures
  3. Summarize guidelines on medical treatment by a health professional of the opposite gender

51.  Describe legal guidelines on medical co-education

52.  Summarize legal guidelines on working with colleagues of the opposite gender

 

DEALING WITH THE FAMILY

53.  Describe the legal position on the rights of visitation by family members

54.  Describe the supportive role of family members in medical care

55.  How can presence of family members reassure the patient

56.  What is your opinion about involving some family members in patient care.

57.  How can a health professional avoid getting into conflict with family members

Prof Omar Hasan Kasule, Sr. August 2005