HOW TO DEAL WITH DOCTORS AND PATIENTS WITH DIFFERENT VALUES

1. HOW TO DEAL WITH DOCTORS AND PATIENTS WITH DIFFERENT VALUES Amanda Howe and Manfred Maier Dept. of General Practice, Medical University of Vienna

2. OVERVIEW • consequences of different values • relevant areas in clinical practice • reasons for having different values • possibilities for dealing with such doctors and patients Dept. of General Practice, Medical University of Vienna

3. OBJECTIVES • participants should be able • to describe possible consequences of an encounter with a colleague/patient who has different values • to compare situations where different values of colleagues/patients may become evident • to discuss possibilities for changing/accepting the values of colleagues/patients Dept. of General Practice, Medical University of Vienna

4. DEFINITION OF CULTURE • The sum total of a set of shared beliefs, values and practices. • Collins English Dictionary Dept. of General Practice, Medical University of Vienna

5. Dept. of General Practice, Medical University of Vienna

6. CONSEQUENCES • negative biases • prejudices • stereotypes about cultural groups • ignorance / lack of consideration • conflicts- misunderstanding- misjudgement • acceptance and enjoyment Dept. of General Practice, Medical University of Vienna

7. Areas where cultural issues are common • Between physician & colleagues / institutions • specialist – generalist (GP / PM) • hospital care – ambulatory care • private health care – public health care • theoretical knowledge – practical knowledge • experience / opinion – evidence based medicine • cultural / ethnic competence – incompetence • biomedicine – complementary medicine – integrative medicine • research orientation – teaching orientation Dept. of General Practice, Medical University of Vienna

8. Areas where cultural issues are common • Between physician and patient / relatives • gender roles • authority within a family system • birth • family, family planning • dying • advance directives • death • etiology and the meaning of illness / mental illness • religion and spirituality • traditional healing methods • wealth and prestige • culture bound syndromes Dept. of General Practice, Medical University of Vienna

9. 13th international Course, Slovenia EURACT Difficulties in interpreting behaviours • There are physical, emotional, language and cultural barriers to successful communication • Even when encouraged to do so, some people find confiding their views and getting feedback difficult • Performance in communication assessment varies with gender and ethnic background • Patients and doctors may disagree about the attributes of a successful consultation • Patients and doctors are capable of accepting behaviours in others which in a broader context are seen as unprofessional and dangerous Dept. of General Practice, Medical University of Vienna

10. 13th international Course, Slovenia EURACT Why are good values not always translated into good behaviours? • Example from junior doctors – barriers were to do with organisational culture: perceptions of risks to status were greater influences than patient care • Example from students – perceive violations of good practice as due to role conflicts, patients being treated as ‘objects’, unavoidable physical circumstances, and lack of accountability • Example from patients – empathy, enablement and being ‘heard’ matter more than technical expertise: patients may be less able to judge lapses of knowledge and skills than to detect negative attitudes • Evidence from education – some complex communicative abilities are ‘hard wired’ and language reliant: values may not be understood via behaviours where cultural differences exist Dept. of General Practice, Medical University of Vienna

11. 13th international Course, Slovenia EURACT Dealing with ‘different’ values – significant event analysis and an ethical framework • SEA • What is happening? • Why is it happening? • What do we want to achieve? • What other information do we need? • How can we do this differently? • Who needs to be involved in improving the situation? • 4 principles and attention to scope • Autonomy • Beneficence • Nonmaleficence • Justice • Level of impact Dept. of General Practice, Medical University of Vienna

12. 13th international Course, Slovenia EURACT Personal devices for dealing with ‘different’ values • Analyse it • What is the level of conflict or potential impact? BACK OFF AND think about it! • Consider if this is a professional or a personal value issue • What guidance can you get from professional codes of conduct • Let the mask slip – be honest with others • Ask advice – from patients, colleagues, third parties • Aim for transparent constructive discussions • Is it a problem? How do you know? – the need for longitudinal evidence • Whose values should dominate? – example of TOP and societal sanction Dept. of General Practice, Medical University of Vienna

13. BACKGROUND - REASONS • environment (society, isolation,..) • genetics • unawareness (lack of education / experience) • professionalization (TCM, CAM, Ayurveda) • ideology • personality Dept. of General Practice, Medical University of Vienna

14. POSSIBILITIES FOR CHANGE • education – long term • information / communication – short term • group practices • feedback (peers, QC, ...) • international exchange / experience • teaching practice • interest in arts (theater,…) Dept. of General Practice, Medical University of Vienna

15. DOKTOR: • Wir haben • das ist erschreckend geehrter Herr • nur immer Wirkungen vor uns • die Ursachen sehen wir nicht • vor lauter Wirkungen • sehen wir keine Ursachen • DOCTOR:It is terrifying, Sir, • but we are always dealing with effects, • the reasons we don‘t see - • due to all the effects • we do not see the reasons. • Thomas Bernhard: Der Ignorant und der Wahnsinnige. Dept. of General Practice, Medical University of Vienna