culture of medicine

7/30/2019 Culture of Medicine

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Culture of Medicine

Prof. dr. Mohammad Hakimi, SpOG(K), PhD.


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Clinical Scenario

1. Yes, I agree with the attending. It is

doctors prerogative to conceal a mistake

2. No, I do not agree with the attending.

Doctors are obliged to disclose medical

errors.


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Background

As medical students proceed through the

clinical rotation at medical school, they meet

tremendous challenges to their professional

development

The "culture of medicine" on the wards and in

the clinics takes its toll on our students


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Background

Most students survive these threats to their

well being and become acculturated to the

world of medicine, albeit, often with residual

feelings of anger, resentment and hostility

Others go on to perpetuate the same practices

on those trainees more junior


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Background

In an effort to make the experience of clinical

rotation more humane, and allow for

discussion and reflection, new policies and

educational programs will be developed at

UGM


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Culture(Merriam-Websters Collegiate Dictionary)

a. The integrated pattern of human

knowledge, belief, and behavior that

depends upon man's capacity for learning

and transmitting knowledge to

succeeding generations


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b. The customary beliefs, social forms, and

material traits of a racial, religious, or

social group


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c. The set of shared attitudes, values, goals,

and practices that characterizes a

company or corporation


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Culture of Medical School


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Adjusting to the Culture of Medicine

In addition to acquiring a great deal of

knowledge, your years in medical schoolare an intense process in acculturation

The culture of medicine has its own

norms, rules and expectations


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Much of this culture is imparted through the

hidden curriculum: what students learn by

observation of role models

Often this new behavior is incorporated without

thinking

Self-reflection and discussion with others canhelp you to consciously process the hidden

curriculum so that you have a choice about the

behaviors you adopt


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There are four categories of

acculturation:

1. Integration occurs when a student maintainsan active interest in both the culture of

origin and the new culture (medicine)

2. In assimilation, a student concentrates onthe new culture but has no interest in the

native culture


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There are four categories of

acculturation:

3. Separation occurs when a student focuseson the culture of origin while being

uninterested in the new culture

4. Finally, marginalization represents theattitude of a student with no interest in

maintaining or acquiring proficiency in

either culture, native or new


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Take a moment to think about where you are

in the midst of your acculturation journey and

how it affects your well-being

For first-year students, the lack of elder

students to guide you through the new

curriculum may wear on your resilience


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Paternalism(Merriam-Websters Collegiate Dictionary)

1. A system under which an authority

undertakes to supply needs or regulate

conduct of those under its control in matters

affecting them as individuals as well as in

their relations to authority and to each other

2. A policy or practice based on or

characteristic of paternalism


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Culture of Medicine

and Medical Error

The culture of medicinewith its emphasis on

professional autonomy, collegiality, and self-

regulationis unlikely to foster the reporting of

mistakes Moreover, the organisational culture of the NHS,

with its emphasis on blame, and an increasingly

litigious public may only serve to exacerbate the

problem

(Lawton and Parker, 2002)


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Culture of Medicine

and Doctor-Patient Relationships Medicine is expert centred

Medical culture tends to maintain patients'

dependence and childlike compliance by means of

power and control, labelling, and treating, whichoften distance the patient from the expert

Medical culture often maintains mystique by using

jargon and withholding information

(Menage, 1997)


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Culture of Medicine

and Preventive Services

Clinical preventive services, such as screening tests,immunizations, and behavioral change counseling,should be a key component of the shift away from areactive, disease-oriented medical culture toward a

proactive, health-based one

But many of these services, studies show, are beinghonored more in the breach than in the observance

(Reynolds, 1998)


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Culture of Medicine

and Medical Education

Deficiencies in education about end-of-life

care are widely recognized, both in the

formal or structured curriculum, and in the

informal curriculum (the culture in which

students are immersed as they learn

medicine)

(Block, 2002)


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Another cultures of medicine

Evidence-based medicine

American Doctor

Patient

Disease-oriented

Others


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Resolution of the clinical scenario

An ethical dilemma. Medical errors and

medical culture. BMJ 2001;322:1236-40.

1236.pdf
http://localhost/var/www/apps/conversion/tmp/scratch_3/1236.pdfhttp://localhost/var/www/apps/conversion/tmp/scratch_3/1236.pdf


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Whistleblower

There are many reasons why doctors remain silent

in similar situations, though two in particular have

impeded openness in the past: Firstly, the culture of medicine has been one in which

you shouldn't let the side down, and in which

whistleblowing is seen as sneaking on your colleagues

Secondly, confidentiality clauses in NHS trust contractseffectively gagged employees

But the culture and the law are changing

culture of medicine

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