B & H VI (GUS) – May 2013 PATIENT AS THE SOURCE OF KNOWLEDGE PATIENT’S SAFETY

1. B & H VI (GUS) – May 2013 • PATIENT AS THE SOURCE OF KNOWLEDGE • PATIENT’S SAFETY AND STUDENT’S SAFETY

2. Patient as the source of knowledge • THE PATIENT IS THE TEACHER • THE STUDENT BEGINS WITH THE PATIENT, CONTINUES WITH THE PATIENT, AND ENDS HIS STUDIES WITH THE PATIENT, USING TEXTS AND FACULTY AS TOOLS Sir William Osler, 1932

3. MEDICAL PROFESSION IS A HELPING PROFESSION → CARE AND CURE TO THE PATIENT AND PATIENT’S RELATIVES → PROFESSIONAL BEHAVIOR SUPPORTED BY STRONG BIOETHICS AND HUMANISM VALUES → BIO-PSYCHO-SOCIO-CULTURAL APPROACH

4. DOCTOR – PATIENT RELATIONSHIP • CRUCIAL IN THE PRACTICE OF MEDICINE • GOOD RAPPORT, EMPATHY, RESPECT • GOOD COMMUNICATION ESSENTIAL IN MEDICAL PRACTICE, ACTIVE LISTENING, HONEST ⇒ when and how , CLEAR INFORMATION, INFORMED CONSENT • BIOPSYCHOSOCIAL MODEL OF DISEASE (GEORGE ENGEL) KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY 7TH ED 1994 KAPLAN AND SADOCK’S SYNOPSIS OF PSYCHIATRY 10TH ED 2007

5. CULTURAL INFLUENCES SOCIO-CULTURAL DIFFERENCES (ETHNICITY, NATIONALITY, RELIGION ETC) INFLUENCE DR/PST PERCEPTION → IMPAIR COMMUNICATION (COMPLAINT, SYMPTOMS PRESENTATION, PST UNDERSTANDING OF ILLNESS AND NEED FOR TREATMENT, RAPPORT)  MISUNDERSTANDING  ASKING, DO NOT ASSUMING HELMAN CG, CULTURE, HEALTH & ILLNESS, 4TH ED, OXFORD, BUTTERWORTH HEINEMANN, p170-201,2000

6. ALTRUISM AND EMPATHY • HEAVY WORKLOADS, STRENUOUS DEMANDS, NON-HUMANISTIC INFORMAL PRACTICES IN MEDICINE → EMOTIONAL SUPPRESSION, DETACHMENT FROM PATIENTS, BURN-OUT → DECREASE OF ALTRUISTIC IDEALS AND QUALITIES OF EMPATHY AMONG MEDICAL STUDENTS • CLINICAL EMPATHY…..an affective and cognitive understanding of the patient’s reactions, thoughts or feelings, followed by a behavioral demonstration of that understanding back to the patients → DECLINING AMONG SENIOR MEDICAL STUDENTS ? BURKS DJ, KOBUS AM, Medical education 2012:46:317-325

7. ALTRUISM • BEING DEVOTED TO OR LIVING FOR THE WELFARE OF OTHERS → “OTHER DIRECTED” • PROSOCIAL ORIENTATION, PROSOCIAL BEHAVIOR → FOCUSES ON HELPING ACT AND POSITIVE BENEFIT FOR BOTH THE RECIPIENT AND THE HELPER • INFLUENCE BY BIOLOGICAL, PSYCHOLOGICAL AND SOCIOCULTURAL FACTORS BURKS DJ, KOBUS AM, Medical education 2012:46:317-325

9. SOFT SKILLS • NO ULTIMATE DEFINITION OF SOFT SKILLS, BUT IT SHOULD INCLUDE ETHICS, ATTITUDES, INTERPERSONAL ABILITIES, COMMUNICATION ABILITIES, INTERPERSONAL AND SOCIAL SKILLS IN A CARING, ETHICAL AND HUMANE PROFESSIONAL DOCTOR-PATIENT RELATIONSHIPS AND BEING A LIFE LONG LEARNER Berg AM, Van Staden CW, SA FamPract 2006;48(8):15; Joubert PM et al, S Afr Psychiatry Rev 2006;9:28-32; SCHULTZ B, JOURNAL OF LANGUAGE AND COMMUNICATION, 2008 • SOFT SKILLS REFER TO THE CLUSTER OF PERSONALITY TRAITS SOCIAL GRACES, FACILITY WITH LANGUAGE, PERSONAL HABITS, FRIENDLINESS, AND OPTIMISM SCHULTZ B, JOURNAL OF LANGUAGE AND COMMUNICATION, 2008

10. EXAMPLES OF SOFT SKILLS SCHULTZ B, Journal of Language and Communication, 2008 • COMMUNICATION SKILLS • CRITICAL AND STRUCTURED THINKING • PROBLEM SOLVING SKILLS • CREATIVITY • TEAMWORK CAPABILITY • NEGOTIATING SKILLS • SELF-MANAGEMENT • TIME MANAGEMENT • CONFLICT MANAGEMENT • CULTURAL AWARENESS • COMMON KNOWLEDGE • RESPONSIBILITY • ETIQUETTE AND GOOD MANNERS • COURTESY • SELF-ESTEEM • SOCIABILITY • INTEGRITY/HONESTY • EMPATHY • WORK ETHIC • PROJECT MANAGEMENT • BUSINESS MANAGEMENT

11. CADAVER • INDISPENSABLE IN MEDICAL EDUCATION • TREAT WITH RESPECT

12. PATIENT AS THE SOURCE OF KNOWLEDGE REG A • NILAI DASAR BIOETIKA-HUMANIORA • SALING PERCAYA • PS ADALAH GURU • MENGASAH ILMU • SANTUN, SUNGUH SUNGGUH, JUJUR, JAGA HARGA DIRI PS • STUDENT DOCTOR → DOKTER (MUDA) • PETUGAS KESEHATAN → KOMPETENSI, SUPERVISI REG B • EXCEPTIONAL LEARNING EXPERIENCES (interaction, information) • RESPECT • GOOD STANDARD OF PRACTICE AND CARE (competence, collaborative, supervision) • IINTRODUCED BY SUPERVISOR (name, role) → (YOUNG) DOCTOR

13. Patient’s safety, Student’s safety • ETHIC PRINCIPLES (BENEFICENCE, NONMALEFICENCE, AUTONOMY, JUSTICE) • INFORMED CONSENT • RESPECT EACH OTHER • STANDARD PROCEDURES • COMPETENCIES • STANDARDIZED PATIENT

14. PROFESSIONALISM IN MEDICINE PRINCIPLES • PRIMACY OF PATIENT WELFARE • PATIENT AUTONOMY • SOCIAL JUSTICE CENTRAL VALUES OF PROFESSIONALISM • Altruism, Accountability, Excellence, Duty and advocacy, Service, Honour, Integrity, Respect for others, Ethical and moral standards McNAIR RP, MEDICAL EDUCATION 2005;39:456-464

15. CLINICAL SKILLS • INTERACTIONS AMONG PATIENTS, INSTRUCTORS AND STUDENTS DETERMINE THE INFORMATION AVAILABLE FOR LEARNING WOOLISCROFT JO, MEDICAL STUDENT CLINICAL EDUCATION, IN INTERNATIONAL HANDBOOK OF RESEARCH IN MEDICAL EDUCATION, 2002 • CONVERTING THEORY INTO PRACTICE KAUFMAN DM, BMJ 2003

16. EXPERIENTIAL LEARNING  LEARNING IS OFTEN MOST EFFECTIVE WHEN BASED ON EXPERIENCE  CYCLICAL PROCESS LINKING CONCRETE EXPERIENCE WITH ABSTRACT CONCEPTUALISATION THROUGH REFLECTION AND PLANING SPENCER J, LEARNING AND TEACHING, IN THE CLINICAL ENVIRONMENTIN ABC OF LEARNING AND TEACHING IN MEDICINE

17. PRACTICAL WORKS, CLINICAL WORKS IS A MUST →PROFFESSIONAL BEHAVIOR • BE HUMANE AND ETHICAL (empathy) • DISCIPLINE, PUNCTUALITY • COMMUNICATION • MASTER ESSENTIAL MEDICAL ABILITY (medical examination, diagnostic, management) • TAKE CARE OF OWN HEALTH AND SAFETY etc

18. PATIENT’S SAFETY, STUDENT’S SAFETY REG A • KOMPETENSI • HATI HATI, PROSEDURAL • PS UMUMNYA MENDUKUNG KEHADIRAN MHS → PS ESENSIAL PD PENDIDIKAN DOKTER • SHOWS, DOES → SKDI • KELELAHAN REG B • CLEAR INSTRUCTION, SUPERVISION • FITNESS TO PRACTICE • GOOD STANDARD OF PRACTICE AND CARE (procedures) • SENSITIVITY TO CERTAIN CHEMICAL COMPOUNDS • A PATIENT IS INDISPENSABLE (interview, physical exam, relationship) • HONEST, INTEGRITY

19. IDEAL PHYSICIAN FOR THE 21st CENTURY  TECHNICALLY PROFICIENT, PROFESSIONAL, HUMANISTIC  BIOMEDICAL KNOWLEDGE, DIAGNOSTIC COMPETENCE, EFFECTIVE COMMUNICATION SKILLS, SOLID AND APPLICABLE UNDERSTANDING OF THE PRACTICE AND ROLE OF PHYSICIANS IN SOCIETY ACQUIRE THE SKILLS, VALUES, ANDATTITUDES THATCOMPRISE A PROFESSIONAL IDENTITY (A CAREGIVER AND A HEALTH PROFESSIONAL)  PERFORM HUMANE, VALUE-CONSCIOUS MEDICALPRACTICE IN THE TREATMENT OF PATIENTS  GOOD RELATIONSHIPS WITH COLLEAGUES