Features of communication

When considering issues of ethical behavior of medical workers, basic and general rules are identified that require compliance regardless of the profile of the medical institution.

The relationship between doctor and patient is the core of any medical practice. According to Hardy, a “doctor, nurse, patient” bond is formed.

The purpose of contact between a patient and a medical professional is the medical care provided by the latter. Based on this, the role of contacts in the “medical worker-patient” interaction system is assumed to be ambiguous. However, it does not at all follow that interest in such interaction exists only on the part of the patient. A medical worker should no less be interested in helping the patient, since this activity is his profession, the choice of which is determined by his own motives and interests.

For effective and conflict-free interaction between a patient and a medical professional, it is necessary communicative competence- the ability to establish and maintain the necessary contacts with people, which can be considered as a system of internal resources necessary for building effective communication in a certain context of situations of interpersonal interaction. It should be noted that in situations where the patient is faced with the need to consult a doctor for help, communicative competence is also important for him. The main thing is that incompetence in communication on at least one side can disrupt the diagnostic and treatment process. The patient’s inability to establish a relationship with a medical professional is just as negative as the latter’s reluctance to establish effective contact with the patient.

The following are distinguished: types of communication:

« Contact masks" - formal communication. The usual masks are used (politeness, courtesy, modesty, compassion, etc.). Within the framework of diagnostic and therapeutic interaction, it manifests itself in cases of insignificant interest of the doctor or patient in the results of the interaction (for example, during a mandatory preventive examination, where the patient feels not independent, and the doctor does not have the necessary data to conduct an objective comprehensive examination and make an informed conclusion ).

Primitive - assessing another according to the degree of “need”. If needed, he actively makes contact; if he interferes, he pushes him away. This type of communication can occur within the framework of manipulative communication between a doctor and a patient in cases where, when visiting a doctor, the goal is to obtain some privileges (for example, sick leave, a certificate, a formal expert opinion, etc.). Interest in the contact participant disappears immediately after receiving the desired result.

Formally - role-playing - regulates the content and means of communication, and instead of knowing the personality of the interlocutor, they make do with knowledge of his social role. Such a choice of type of communication on the part of the doctor may be due to professional overload.

Business - takes into account the personality characteristics, age, mood of the interlocutor while focusing on the interests of the matter, and not on possible personal differences. When a doctor communicates with a patient, this type of interaction becomes unequal. The doctor, considering the patient’s problems from the point of view of his own knowledge, makes decisions autonomously without the consent of the person concerned.

Manipulative - aimed at extracting benefits using special techniques. There is a manipulative technique called “hypochondrization of the patient,” the essence of which is to present a doctor’s conclusion about the patient’s state of health in the light of a clear exaggeration of the severity of the detected disorders. The purpose of such manipulation may be to reduce the patient’s expectations for the success of treatment, associated with the desire of the medical worker to avoid responsibility in the event of an unexpected deterioration in the patient’s health, as well as to demonstrate the need for additional and more qualified actions by the medical worker to receive compensation.

Currently, many experts insist on the need to exclude such a concept as “sick” from the lexicon and, accordingly, the communication process, replacing it with the concept “patient”, in view of the fact that the term “sick” has a certain psychological load. Address sick people: “How are you, sick?” unacceptable. It is possible to address the patient by name and patronymic, especially since the sound of the name is psychologically comfortable for him.

Tactical actions of a medical worker

Communication with the patient - the most important element of the treatment process - is an art that must be mastered in order to successfully interact with him.

When entering a hospital environment, the life stereotype of a person changes, who is overcome by feelings of melancholy, loneliness, and fear, caused not only by the disease itself, but also by isolation from home, family, colleagues, and from everything that was previously familiar. If the hospital is clean, cozy and neat, and the health worker looks just as neat, then this already wins the patient over, arouses respect for the medical profession, putting him in a positive mood and thereby providing a beneficial therapeutic effect. Clothing, facial expression, and demeanor reflect some aspects of the health worker’s personality. Based on the characteristics of the aspects of a health worker’s personality, one can assume, in particular, the degree of her care, attention to the patient, and ability to empathize.

One of the foundations of therapeutic activity is the ability of a medical worker to understand and listen to the patient, which helps to diagnose the disease and has a beneficial effect on establishing psychological contact between the medical worker and the patient.

The need to take into account the characteristics (profile) of the disease, which is of no small importance when contacting the patient. In the therapeutic departments there are patients with diseases of various organs and systems: diseases of the cardiovascular system, gastrointestinal tract, respiratory system, kidneys, etc. Often their diseases are chronic and require long-term treatment; accordingly, they are in the hospital for a long time, which influences the process of relationship between the medical worker and the patient. Isolation from family and usual professional activities, concern for the state of one’s health cause various psychogenic reactions in the patient.

As a result of psychogenic disorders, the course of the underlying somatic disease may worsen, which in turn complicates the mental state of patients. It should be noted that in therapeutic departments there are patients with complaints of disorders of internal organs, often without even suspecting that these are somatic disorders of a psychogenic nature.

Complaints of various kinds and ethical problems that arise indicate a lack of necessary psychological knowledge and practically appropriate communication between medical workers and patients.

Differences in the perspectives of the health care worker and the patient may be due to their social roles and other factors. While the doctor identifies, first of all, objective signs of the disease, seeks to limit the anamnesis to determine the prerequisites for further somatic research, etc., the focus of attention and interests of the patient is the subjective, personal experience of the disease. With this in mind, the clinician must analyze these subjective sensations as actual factors.

He needs to try to feel or grasp the patient’s experiences, understand and evaluate them, find the causes of anxiety and worries, support their positive aspects, which can be used to more effectively assist the patient during examination and treatment.

The medical professional's reaction should resonate with what he hears.

The personality characteristics of a medical worker, as well as the individual characteristics of the patient and his psyche, influence the establishment of positive psychological relationships and trust between medical workers and patients. Primary responsibility for the nature of these relationships, so important for successful treatment, rests with the health care professional. To do this, you must be a qualified specialist, have experience and master the art of communication, and adhere to the principles of ethics and deontology.

The effectiveness of treatment largely depends on the patient’s faith in recovery, which in turn is closely related to the degree of trust that he has in the doctor and medical staff of the department.

To build trust in a medical professional, the patient’s first impression of meeting him is important. This includes the medical worker's facial expressions, gestures, tone of voice, facial expression, manner of speaking, as well as his appearance. The direct responsibility of medical workers is to break the psychological barrier in contact with patients, to inspire their trust, based on participation and warmth. The strength of the contact between the doctor and the patient directly depends on the degree to which the patient supports the desire to talk about himself.

A medical worker can earn the patient’s trust if he is harmonious, calm, confident, but not arrogant, his demeanor is persistent and decisive, accompanied by human participation and delicacy. Only after establishing contact with the patient can we proceed to assessing the results of tests and other auxiliary examination methods. It is necessary to make it clear to the patient that the medical workers to whom he turned for help are interested not only in diagnostic issues, but also in the person who turned to them. The patient's trust in medicine can be seriously undermined if he notices that the relationship between the doctor and the nurse is strained, if the nurse makes irrelevant remarks during the appointment, or does not clearly follow the doctor's orders. When making a serious decision, the doctor must imagine its results, the consequences for the health and life of the patient, and increase his sense of responsibility.

The work of a medical worker has special requirements - the need to be patient and self-controlled. This is due to great emotional tension that arises when communicating with patients, increased irritability, demandingness, and painful sensitivity.

There are facts where people with unbalanced, insecure and absent-minded manners gradually harmonized their behavior towards others. This was achieved both through one’s own efforts and with the help of other people. However, this requires certain psychological efforts, work on oneself, a certain critical attitude towards oneself, which for a health worker is and should be taken for granted.

The health care worker should provide for various options for the development of the disease and not consider reluctance to be treated as ingratitude or even a personal insult on the part of the patient if the patient’s health does not improve. In certain situations, it is appropriate to show a sense of humor, but without a hint of ridicule, irony and cynicism, according to the well-known principle “laugh with the sick, but never the sick.” It should be noted that some patients cannot tolerate jokes made with the best intentions and perceive them as disrespect and humiliation.

The work of a doctor and medical worker is rich in a variety of situations, has dynamics and contradictions. In order to correctly draw a moral line through the changing diversity of life, you need to learn to gain experience. The peculiarities of medicine consist not only in the external aspect of the conditions of activity, but, above all, in their semantic significance for a person’s destiny. This is a field of activity where there are no little things, no unnoticed actions, views, or experiences. Here everything, even the insignificant everyday fact of human participation, excites with no less force than large vital deeds. Conscientiousness and decency, generosity and goodwill, nobility and attention, tact and politeness in everything that concerns the life and health of the patient should act as habitual, everyday norms of behavior. M.Ya. Mudrov pointed out: “Whatever you do, don’t do it at random, don’t do it haphazardly.” These qualities must be embodied in practice and working conditions of medical institutions.

The concept of the quality of a health worker’s activity is not just the sum of personality traits, but their organic union based on practical skills that answer the questions: “What should be done” and “How should it be done.” The quality and culture of work of a medical worker are associated with the concept of a way of working. The object of medical activity, regardless of medical specialty, is at the same time a subject, a person. This implies the requirement: in the activities of a doctor, under any conditions, the human factor must be taken into account.

Outside the concept of the nature of the activity of the doctor-patient relationship, the latter becomes a mere case for the doctor, and his social functions are reduced to the formal duty of making appointments in accordance with the variations of cases. Medicine has always been looked at as something much more, an active, full-blooded social relationship in which the doctor sees his calling and a way of self-expression of the human essence, and the patient sees understanding, compassion, relief, and comprehensive assistance in preserving life and health.

Despite the establishment of contact and the further development of positive relationships between the doctor and the patient, these relationships may be complicated by some negative character traits of the medical worker (anger or, conversely, isolation with weak emotional reactions). The patient loses trust, and the medical worker loses authority if the patient develops the impression that the health worker is a “bad person.” For example, the patient hears how the latter speaks badly about his colleagues, sees how he treats his subordinates arrogantly and panders to his superiors, observes a lack of self-criticism, etc. Such observations may lead the patient to believe that the doctor or nurse will be equally bad professionals.

Personality characteristics of a medical worker.

The main personality traits of a medical worker include:

Moral - ( dedication, hard work, goodwill, optimism, determination, modesty, integrity, responsibility, self-esteem, compassion, care, tenderness, affection, honesty);

Aesthetic (neatness, neatness);

Intelligent - logic , observation, desire for knowledge ).

The condition for success in relationships and professional activities is the appropriate education of the emotional sphere of the individual, which, first of all, is manifested in whether a person knows how to empathize with other people, rejoice and be upset with them.

Communication plays an important role in people’s lives and activities. Without communication, it is impossible, for example, to develop culture, art, or living standards, because Only through communication is the accumulated experience of past generations transferred to new generations. A pressing issue today is communication between health care workers and patients. Many of us have been to a hospital, clinic, or some other medical facility where each of us interacted with a doctor or nurse. But has anyone ever thought how much this communication influences us, or rather the course of our disease, and how a health care worker can improve our condition? Of course, we can say that everything depends on the medications that the doctor prescribes and the nurse gives us, and the medical procedures are also prescribed by the doctor, but this is not all that is necessary for a complete recovery. The most important thing is the right attitude, which depends on the mental and emotional state of the patient. The patient's condition is greatly influenced by the attitude of the health worker towards him. And if the patient is satisfied, for example, with a conversation with a doctor who listened to him carefully, in a calm atmosphere and gave him appropriate advice, then this is the first step towards recovery.

In everyday life, we often hear about “good” or “correct” treatment of a patient. And in contrast to this, unfortunately, we hear about a “soulless”, “bad” or “cold attitude towards sick people. It is important to note that various kinds of complaints and ethical problems that arise indicate a lack of necessary psychological knowledge, as well as the practice of appropriate communication with patients on the part of health workers. Differences in the views of the health worker and the patient.

Differences in the perspectives of the provider and the patient may be due to their social roles, as well as other factors.

For example, a doctor is inclined to look, first of all, for objective signs of a disease. He tries to limit the history to further determine the prerequisites for further somatic examination, etc. And for the patient, the center of attention and interests is always his subjective, personal experience of the disease. In this regard, the doctor must consider these subjective sensations as real factors. He should even try to feel or grasp the patient’s experiences, understand and evaluate them, find the causes of anxieties and worries, support their positive aspects, and also use them to more effectively assist the patient in his examination and treatment. The differences in all the views and points of view of the doctor (nurse) and the patient are quite natural and predetermined, in this situation, by their different social roles. However, the doctor (nurse) must ensure that these differences do not develop into deeper contradictions. Since these contradictions can jeopardize the relationship between the medical staff and the patient, and thereby complicate the provision of care to the patient, complicating the treatment process. To overcome differences in views, the health care worker must not only listen with great attention to the patient, but also try to understand him as best as possible. What happens in the soul and thoughts of a sick person? The doctor must respond to the patient's story with all his knowledge, reason, and the fullness of his personality. The health worker's reaction should resonate with what is heard.

Communication with the patient is the most important element of the treatment process.

The art of taking anamnesis is not an easy art. In the language of psychologists, this is a controlled conversation designed to collect anamnestic data, and the conversation should be controlled unnoticed. The patient with whom the conversation is being conducted should not feel this. In the process of collecting an anamnesis, he should have the impression of a relaxed conversation. In this case, the doctor needs to assess the seriousness of the complaints, the manner of their presentation, separate the main from the secondary, make sure of the reliability of the testimony without offending the patient with mistrust, help to remember without indoctrination. All this requires great tact, especially when it comes to clarifying the state of mind, mental trauma, which plays a large role in the development of the disease. When questioning a patient, one must always take into account his cultural level, degree of intellectual development, profession and other circumstances. Empty, meaningless words and indulgence in the unreasonable whims and demands of some patients should be avoided. In other words, it is impossible to offer a standard form of conversation between a health worker and a patient. This requires ingenuity and creativity. Particular attention should be paid to elderly patients and children. The attitude of a doctor or nurse towards a child, a mature patient and an old man, even with the same illness, should be completely different, which is due to the age characteristics of these patients.

It should be noted that a prerequisite for the emergence of positive psychological relationships and trust between health workers and patients is the qualifications, experience and skill of the doctor and nurse. At the same time, the result of expanding and deepening information in modern medicine is the increased importance of specialization, as well as the creation of various branches of medicine aimed at certain groups of diseases depending on the location, etiology and methods of treatment. It can be noted that specialization carries with it a certain danger of the doctor’s narrowed view of the patient.

Medical psychology itself can help level out these negative aspects of specialization thanks to a synthetic understanding of the personality of the patient and his body. And qualification is only a tool, the greater or lesser effect of its use depends on other aspects of the doctor’s personality. One can note Gladky’s definition of the patient’s trust in the doctor:

“Trust in a doctor is a positive dynamic attitude of a patient towards a doctor, expressing a previous experience-based expectation that the doctor has the ability, means and desire to help the patient in the best possible way.”

Note that a health worker is a young specialist, about whom patients know that he has less life experience and less qualifications, is in a search for the trust of patients and is at a disadvantage compared to his senior colleagues with work experience. But a young specialist can be helped by the knowledge that this deficiency is temporary, which can be compensated for by conscientiousness, professional growth and experience.

It should be noted that the personal shortcomings of a health worker may lead the patient to believe that a doctor or nurse with such qualities will not be conscientious and reliable in the performance of their immediate official duties.

In general, the balanced personality of a health worker is for the patient a complex of harmonious external stimuli, the influence of which takes part in the process of his treatment, recovery and rehabilitation. A health worker can educate and shape his personality, including by directly observing the reaction to his behavior. Let's say, based on conversation, assessment of the patient's facial expressions and gestures. Also indirectly, when he learns about his view of his behavior from his colleagues. And he himself can help his colleagues, direct them towards more effective psychological interaction with patients.

Types of nurses and their characteristics:

I. Hardy describes 6 types of sisters according to the characteristics of their activities.

Sister-routineer. Its most characteristic feature is the mechanical performance of its duties. Such nurses perform the assigned tasks with extraordinary care, scrupulousness, showing dexterity and skill. Everything that is needed to care for the patient is done, but there is no care itself, because it works automatically, indifferently, without worrying about the sick, without sympathizing with them. Such a nurse is capable of waking up a sleeping patient just to give him sleeping pills prescribed by the doctor.

The sister "playing a learned role." Such sisters, in the process of work, strive to play some role, striving to realize a certain ideal. If their behavior crosses acceptable boundaries, spontaneity disappears and insincerity appears. They play the role of an altruist, a benefactor, showing “artistic” abilities. Their behavior is artificial.

The type of "nervous" sister. These are emotionally labile individuals prone to neurotic reactions. As a result, they are often irritable, quick-tempered, and can be rude. Such a sister can be seen gloomy, with resentment on her face, among innocent patients. They are very hypochondriacal, afraid of contracting an infectious disease or getting a “serious illness.” They often refuse to perform various tasks, allegedly because they cannot lift weights, their legs hurt, etc. Such nurses interfere with their work and often have a harmful influence on the sick.

Sister type with a masculine, strong personality. Such people can be recognized from a distance by their gait. They are distinguished by persistence, determination and intolerance to the slightest disturbances. They are often not flexible enough, rude and even aggressive with patients; in favorable cases, such nurses can be good organizers.

Maternal type sister. Such nurses perform their work with maximum care and compassion for the sick. Work is an integral condition of life for them. They can do everything and succeed everywhere. Caring for the sick is a life calling. Their personal lives are often imbued with concern for others and love for people.

Type of specialist. These are sisters who, due to some special personality trait or special interest, receive a special assignment. They dedicate their lives to performing complex tasks, for example in special laboratories. They are fanatically devoted to their narrow activities.

Conclusion. The role of the health worker in communication with the patient.

As in everyday life, so in healing activities, there is communication. In both cases it has a certain meaning and psychological characteristics. In medical activities, there are several types of communication between a health worker and a patient. And it depends only on the health worker what type of communication he will have with the patient. But in any case, the doctor or nurse must follow certain tactics in relation to the patient and, most importantly, the health worker, as an individual, must have certain characteristics in all respects in order to earn the patient’s trust in him. After all, without trust, normal relationships between a health worker and a patient are impossible. Because The nurse spends more time in direct contact with the patient; her role in communicating with the patient becomes important. Consequently, the personality of the nurse, the style and methods of her work, the ability to influence and treat patients is an important element not only of the treatment process, but also of the psychological communication between the medical worker and the patient.

Extract from the Code of Medical Ethics

Doctor-nurse relationship

References

Ethics of relationships in the medical team.

In the course of his work, the doctor is constantly in contact with colleagues - with his senior and junior colleagues, specialists of other profiles, doctors of paraclinical services (radiographers, endoscopists, clinical laboratory assistants, immunologists), as well as with pharmacists, paramedics and junior medical workers. In this regard, in the medical profession, the establishment of correct relationships between medical workers, continuity and coherence in the work of all levels of the medical service, on which the timeliness and quality of medical care depends, acquires a special role.

That is why, already in the works of Hippocrates, it is recommended in difficult cases to invite other doctors for consultation. The Oath of the Russian Doctor and the Oath of the Doctor, adopted as a “federal law,” encourage doctors to seek advice from colleagues and never refuse selfless help. The “Ethical Code of the Russian Doctor” states that “in relationships with colleagues, the doctor must be honest, fair, friendly, decent...” The “International Code of Medical Ethics” additionally notes that “the doctor... must fight with those of his colleagues who display incompetence or are found to be deceitful.”

Thus, correct relationships between doctors among themselves in the course of their activities are achieved if two basic conditions are met:

1) respect for your colleague, avoiding bullying of the doctor in the presence of the patient, since such violations undermine the patient’s faith in his doctor and, therefore, harm the patient;

2) the doctor turns to his colleague for advice in all cases that are difficult to diagnose and treat.

The medical profession itself contains the principle of collegiality and collectivism, the need for the closest cooperation in the interests of the patient. It is important to take into account the opinion of every doctor, regardless of his experience and age. All members of the medical team should be vitally interested in the need for normal relationships. Moreover, to successfully carry out their hard work, doctors must support each other morally, protect each other from worries and mental anxieties. Meanwhile, in practical work there are still often cases when doctors speak unkindly about their colleagues in the presence of patients.

One of the options for treating colleagues incorrectly is spreading defamatory rumors about them, for example, their “medical errors” or improper treatment. Sometimes such slander is justified by the struggle of various clinical schools and is intended to discredit not so much a specific doctor as this or that medical team.

A disparaging statement about a colleague, especially in the presence of a patient, is a gross violation of medical ethics, and has always been condemned by doctors and the public. Violations of medical deontology appear somewhat more often in the attitude of older colleagues to younger ones. In teams with a healthy microclimate, a caring attitude towards a junior colleague is observed, and if errors in diagnosis and treatment are identified, then comments are made in a friendly and correct form, best in private and never made in the presence of the patient. An important quality of a leader is the ability to listen to the opinions of junior comrades. Such relationships in a team contribute to more effective work, raise the authority of doctors and benefit the patient.

Successful work in a medical team also largely depends on the well-coordinated work of doctors with middle and junior medical staff. Nurses and aides are constantly at the patient’s bedside and can notice manifestations of the disease that the doctor did not observe. A huge number of patients were saved only because nurses noticed a deterioration in the patient’s condition in time, which made it possible to provide emergency care in a timely manner. That is why a doctor must establish and strengthen a businesslike and respectful attitude towards his assistants and never treat them from a position of personal superiority.

Nurses and aides provide an invaluable service in caring for the sick and caring for the sick. Lack of proper care often negated the best efforts of doctors, including the results of excellent surgical interventions.

In all difficult cases, the doctor is obliged to seek advice from a more experienced colleague. Seeking help from another doctor does not indicate poor professional training of the doctor himself, but, on the contrary, a serious and thoughtful approach to performing his medical duties, and the doctor’s responsibility to his patients. Failure of a doctor to seek advice from his more experienced colleague in cases that are difficult to diagnose and treat is a serious deontological violation. Such a violation can have serious, sometimes fatal, consequences for the patient.

Extract from the Code of Medical Ethics

SECTION IV. Relationships with colleagues

ARTICLE 28. In relationships with colleagues, a doctor is required to be honest, fair, benevolent, decency, respectful of the knowledge and experience of colleagues, and willing to selflessly pass on his experience and knowledge to them.

ARTICLE 29. Criticism of colleagues must be reasoned, non-offensive and non-defamatory. It is not the personality of colleagues that is criticized, but their professional actions.

ARTICLE 30. Negative statements about your colleagues in their absence and especially in the presence of patients, their relatives or strangers are unacceptable.

ARTICLE 31. To protect honor and dignity, a doctor can contact the Medical Ethics Commission and law enforcement agencies.

ARTICLE 32. The doctor has no right to prevent the patient from choosing another attending physician. A doctor creates his professional reputation only on the basis of his work results and should not engage in self-promotion. At the same time, he has the right to disseminate information about his professional skills and qualifications.

ARTICLE 33. A doctor must constantly maintain gratitude and respect for his teachers and colleagues who taught him the art of medicine.

ARTICLE 34. The doctor must do everything in his power to create a favorable moral and psychological climate in the work team, actively participate in the work of the medical association, protect the honor and dignity of his colleagues, and prevent the medical practice of dishonest and incompetent colleagues and non-professionals who harm the health of patients.

ARTICLE 35. The doctor is obliged to treat nursing and junior medical personnel with due respect, as well as to help improve their professional knowledge and skills.

Doctor-nurse relationship

Psychiatric practice relies heavily on good communication between nurses and physicians. When mutual understanding is lacking or compromised, the quality of care deteriorates. Historically, the relationship between doctors and nurses has acquired the status of a special relationship. This is especially true within hospital settings and in the treatment of persons with serious mental illness, where the physician and nurse become the dominant couple, influencing other multidisciplinary interactions and especially the nature of the relationship with patients.

Today, modern psychiatry is present in a variety of settings in addition to acute inpatient units, particularly in community mental health centers, patients' homes, and numerous wards in residential and institutional settings caring for people with mental disorders. These different types of human environments influence the nature of relationships simply because they create different styles of work arrangements and define different roles for the participants.

As a consequence, the nurse-doctor pair is no longer exclusive (unique). Almost all psychiatry operates within a multidisciplinary structure, and interactions with other professionals such as psychiatric social workers, occupational therapy specialists, psychologists, external organizations and those responsible for comprehensive patient care affect the doctor-nurse relationship, diluting their “specialness”.

Changes in the workplace are reflected in professional and institutional (organizational) norms (eg, forensic duties and work shifts) that shape the nature of interactions, setting expectations and requirements.

The nature of education for nurses and physicians is undergoing many changes, with the boundaries between physicians as diagnosticians and prescribers and nurses as orderers and drug dispensers becoming less clear and more permeable.

The doctor-nurse relationship is influenced in part by what patients think of them. Radcliffe (2000) argued that power in relationships is mediated by the patient: “When in doubt, ask the patient who is in control. People may love their angels, but they are in awe of their doctors.” This reflects the traditional, popular view of the roles of doctors and nurses. However, patients' expectations of what nurses and doctors do and do not do are changing rapidly. Increased publicity regarding medical and nursing errors and the use of the Internet have taken some of the magic and gloss off these professions (Stein et al, 1990).

In the hospital setting, traditional relationships changed slowly. Institutional and professional norms still rely on physician decision-making, a code of conduct for nurses, and a hierarchy of managerial accountability. The inpatient facility highlights the main aspect of the doctor-nurse relationship - interdependence. Neither of them can work independently of the other. If the psychiatrist is a medical officer and the patient is an inpatient under a particular section of the Mental Health Act, the psychiatrist is dependent on nurses to provide care and safe treatment for the patient while in hospital. Nurses rely on physician authority and forensic responsibility to support them and help them cope.

However, the physician in psychiatry still retains significant power and responsibilities that influence interdependence: for example, he decides, formally or informally, which patients are admitted and discharged. Under Section 12 of the Mental Health Act 1983, doctors have specific duties that cannot be shared with other professional groups.

Traditionally, physicians have been viewed as the repository of clinical knowledge and as responsible for keeping up with the latest advances in science, passing on this knowledge not only to their own students, but also to the nurses working on their team. From a public perspective, university education, as opposed to hospital experience, is seen as an indication that doctors are “educated, whereas nurses are merely professionally trained” (Warelow, 1996). Therefore, tacit knowledge is a source of power differentials that underpin the doctor–nurse relationship. This difference has been reduced in part by the expansion of university-based training for nurses as part of the Ministry of Health's Project 2000 (United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1986). However, some critics have noted that there is a gap between theory and practice and that training during training is deficient because it does not match the actual nature of service needs (Department of Health, 1997). Collaborative learning (with clinicians and other professional groups) is beginning to occur in areas such as legislation under the Mental Health Act, the use of National Health Status Scores (HoNOS) and ethical issues.

References

1. Saperov V.N. - “Medical ethics from Hippocrates to the present day”, - Cheboksary, 2001

2. Petrovsky B.V. - “Deontology in medicine.” - M.: Medicine, 1988

3. Global computer network "Internet"

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Doctor-patient relationship

Deontology and ethics of medical practice. The art of conversation and the psychological impact of a doctor on a patient. The key to successful treatment is the relationship between the doctor and the patient, based on trust, support, understanding, empathy, and respect.

It is no secret that cases of litigation, including financial claims, where medical workers are defendants, are now becoming more frequent. Statistics confirm that most lawsuits are caused by conflict situations in relationships with patients. Complaints, as a rule, arise not about the quality of medical care, but about the callousness and formalism of doctors. This cannot be explained by the humiliating salaries of medical workers: after all, this situation is developing not only in our country. Last year, the Association of American Medical Colleges surveyed patients asking what criteria they would use when choosing a doctor. In the first place were communication skills and the ability to explain to the patient the essence of complex medical procedures. The fact that the doctor came from a prestigious educational institution was in last place. Over the millennia of medicine, the art of communication between doctor and patient still retains great importance, if not paramount importance.

In past centuries, the role of the doctor was often reduced to simply observing the natural course of the disease. Until recently, the style of relationship was that the patient trusted the doctor with the right to make decisions. The doctor, “solely in the interests of the patient,” acted as he saw fit. It seemed that this approach increases the effectiveness of treatment: the patient is freed from doubts and uncertainty, and the doctor takes full care of him. The doctor did not share his doubts with the patient and hid the unpleasant truth from him.

There are several models of communication between doctor and patient:

informational (dispassionate doctor, completely independent patient);

interpretive (persuasive doctor);

deliberative (trust and mutual agreement);

paternalistic (doctor-guardian).

For poorly educated people, an interpretive model is more suitable; for educated people who delve into the essence of health problems, a deliberative model is more suitable. The paternalistic model, which was widespread earlier, involves a violation of the patient’s rights and is not used today, with the exception of situations that pose an immediate threat to the patient’s life, when it comes to emergency surgery and resuscitation measures.

However, trust based on blind faith should be distinguished from trust deserved. Currently, the doctor and the patient cooperate, share doubts, tell each other the truth, and equally share responsibility for the outcome of treatment. Such cooperation is built on support, understanding, sympathy, and respect for each other.

One of the most important conditions for establishing mutual understanding between the doctor and the patient is the feeling support . If the patient realizes that the doctor intends to help and not force, then he is likely to participate more actively in the treatment process. When the doctor shows understanding , the person is sure that his complaints are heard, recorded in the mind of the doctor, and he is considering them. This feeling is strengthened when the doctor says: “I hear and understand you” - or expresses this with a glance or a nod of the head. Respect implies recognition of the value of a person as an individual. This is especially important at the stages of collecting anamnesis, when the doctor gets acquainted with the circumstances of the patient’s life. Sympathy – the key to establishing cooperation with the patient. You need to be able to put yourself in the patient’s shoes and look at the world through his eyes. It is important to understand and take into account the internal picture of the disease - everything that the patient experiences and experiences, not only his local sensations, but also his general well-being, self-observation, his idea of ​​his illness, its causes.

There are no strict rules for communicating with a patient, although doctors all over the world use the general principles of deontology (from the Greek deon- due and logos– teaching) – professional ethics of medical workers. The patient’s state of mental comfort is the main criterion of deontology, a test of its effectiveness. The oath, which is only conventionally called the Hippocratic Oath, has roots in the very distant past. Later it was drawn up as a document and contained several basic requirements for the doctor, in particular:

maintaining medical confidentiality;

prohibition of actions that could cause moral or physical harm to the patient or his relatives;

dedication to the profession.

It is curious that in different countries the ancient oath remained virtually unchanged throughout the 17th centuries. Having undergone several “editions” in our country, it was only called differently – “Faculty’s Promise” in pre-revolutionary Russia, “Oath of a Soviet Doctor” - later.

One of the most important things in a doctor’s work is the prohibition of actions that can harm the patient, or the “do no harm” principle. The oldest and probably the most important statement of medical ethics in its Latin formulation is: primum non nosere(“First of all, do no harm”). Any doctor will probably agree with E. Lambert’s statement that “there are patients who cannot be helped, but there are none who cannot be harmed.” After all, it is known that sometimes the treatment can be worse than the disease. We are talking about the side effects of drugs, negative effects when using a large number of drugs simultaneously, and the discrepancy between the predicted benefits and the possible risks of medical intervention.

But a good doctor is not only professionalism, encyclopedic knowledge, informed decisions and perfect mastery of the technique of medical manipulation, but also the ability to speak with the patient.

By the way, the word “doctor” comes from the well-known “to lie”, which, however, in the old days had a completely different meaning – “to speak”, “to talk”. Observations show that experienced doctors pay more attention to communication with the patient, collecting anamnesis and physical examination, and place the data of instrumental and laboratory studies at a lower rank. It has been proven that the correct diagnosis based on anamnesis is made in 45–50% of patients, and based on a survey and physical examination methods – in 80–85% of patients. Only 15–20% of patients require in-depth laboratory and instrumental examination to make a diagnosis.

Unfortunately, doctors master communication skills “spontaneously”; this comes with years and acquired experience. This is practically not taught specifically in medical universities. It is sad to see if a doctor neglects to talk with a patient, becoming a blind hostage of laboratory and instrumental diagnostics or a weak-willed executor of treatment regimens and directives issued from above. The art of conversation with a patient, the ability to conduct a dialogue with a patient requires not only the desire of the doctor, but also, to a certain extent, talent. The doctor must be able to not only listen, but also hear patient.

Let us note one more immutable fact: the conversation with the patient must be one-on-one, the presence of third parties is excluded. Information about a patient over 15 years old cannot be disclosed to strangers and even relatives without his consent. Maintaining medical confidentiality is, as you remember, one of the provisions of the Hippocratic Oath.

According to the current legislation (“Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens”), the patient has the right to receive information about his health, agree to treatment or refuse it (the provision on the informed consent of the patient), and demand and receive financial compensation in case of damage to health. The patient must be aware of the nature of the disease, the existing risk, prospects and methods of treatment, the possibility and degree of family participation in the implementation of treatment programs. It is always difficult for a doctor to talk about an unfavorable prognosis of a disease or a high risk of any manipulation. A person should be given positive information that sets him up for the prospect of even minimal improvement. After all, a 60% chance of an unfavorable outcome of the operation simultaneously means a 40% chance of recovery.

The doctor, telling the patient the truth, must also instill hope in him. However, it is necessary to tell the truth: only after weighing all the pros and cons can a person agree or refuse the proposed treatment. The patient has the right to know which symptoms should disappear completely, which ones should disappear partially, and which ones will remain, and their existence will need to be accepted. Calm, thoughtful, sympathetic words from a doctor, even if he reports probabilistic and non-guaranteed results, can reassure the patient. I would like to quote B. Seigel: “You should never say that there is nothing more you can do, even if the only remedy left to you is to be there and help the sick person hope and pray.”

It has long been known that doctors can influence a disease without any drugs. The doctor’s authoritative word can influence the patient’s well-being: the doctor’s confidence is transferred to the patient.

Once at the dacha, during a summer vacation, one famous doctor was asked to examine a neighbor who felt pain in the left side of his chest. The thought that it was a heart attack caused panic. When the doctor entered the patient's room, he was lying on the sofa. There was anxiety and confusion in his eyes, and he was mentally prepared for the worst. After several detailed questions and examination, the doctor noted that the pain was probably a symptom of an exacerbation of osteochondrosis. As the doctor calmly, with confidence in his voice, spoke about his observations, the patient’s well-being improved before our eyes. The anxiety passed, emotional depression was replaced by a willingness to fight to improve one’s well-being. All that was left was some painful sensation.

How to make communication with a patient as effective as possible? Can communication be taught? Some recommendations have already been made, a few more such tips are given below.

Try to find out the reasons for the patient's subconscious anxiety. Help them understand them by bringing the problem to the level of consciousness.

Try to give the patient specific instructions about what to do, what to strive for, how to behave.

When talking to older people, do not remind them of their age. The conversation should be unhurried, specific questions should be asked that require an unambiguous answer.

Try to avoid oral advice alone; write down recommendations on regimen, diet, and drug therapy on a piece of paper.

Try to explain the need to limit, if possible, contact with factors that destroy the psyche (excessive information load, stress, and so on).

Try to convince the patient that maintaining and improving health requires a comprehensive approach, including non-drug measures. Fresh air, forest, sun - these are just some of the factors that can affect your well-being.

Without a doubt, the doctor-patient relationship is multifaceted. This is a large complex of psychological, moral and ethical problems that a doctor has to constantly deal with. Sometimes non-medical questions arise. For example, it is known that medicine is still in a difficult financial situation. In public medical institutions there is often a shortage of medicines and dressings, staff wages are low... And at the same time, newspapers and websites are full of advertisements for so-called prescription part-time work for doctors, and the potential employer does not skimp on indicating possible earnings. The temptation is great! And the essence of such proposals is simple: the doctor must convince, persuade his patient to buy the drug, and more often - a dietary supplement, for a certain reward - a percentage of the cost of the drug, which will constitute the doctor’s earnings. The principle “the more you sold, the more you received,” although it fits well into the system of market relations, is, in our opinion, unacceptable in medicine - it is a dead-end path leading to the patient’s refusal of treatment and a decrease in the doctor’s authority. But there is another way: the use of the latest information regarding qualified synonymous and analog replacement of drugs, as well as the use of modern medicines and forms that improve the well-being, health and quality of life of patients, leads to strengthening the authority of the doctor and, as a result, an increase in his social position . So isn’t it better to remain in harmony with your conscience and achieve material well-being in an honest way?

The doctor must have a subtle psychological sense, and constant work of consciousness is necessary here. Success in treatment is possible through a combination of trusting human relationships and scientific advances. And for this, a technically equipped doctor must not only treat, but also be able to talk with his patient.

Deontology and ethics in medicine have always been of great importance. This is due to the specific nature of the work of hospital staff.

Fundamentals of medical ethics and deontology today

Currently, the problem of relationships (both within the workforce and with patients) has acquired particular importance. Without the coordinated work of all employees, as well as in the absence of trust between the doctor and the patient, it is unlikely that serious success will be achieved in the medical field.

Medical ethics and deontology are not synonymous. In fact, deontology is a kind of separate branch of ethics. The fact is that she is an inferior complex of only a professional person. At the same time, ethics is a much broader concept.

What can deontology be?

Currently, there are several variants of this concept. It all depends on what level of relationship is being discussed. Among their main varieties are:

• doctor - patient;
• doctor - nurse;
• doctor - doctor;
• - patient;
• nurse - nurse;
• doctor - administration;
• doctor - junior medical staff;
• nurse - junior medical staff;
• junior medical personnel - junior medical personnel;
• nurse - administration;
• junior medical staff - patient;
• junior medical staff - administration.

Doctor-patient relationship

This is where medical ethics and medical deontology are most important. The fact is that without observing them, a trusting relationship is unlikely to be established between the patient and the doctor, and in this case the process of recovery of the sick person is significantly delayed.

In order to gain the patient’s trust, according to deontology, the doctor should not allow himself unprofessional expressions and jargon, but at the same time he should clearly tell the patient both the essence of his disease and the main measures that must be taken in order to achieve a full recovery. If the doctor does exactly this, then he will definitely find a response from his ward. The fact is that the patient can trust the doctor 100% only if he is truly confident in his professionalism.

Many doctors forget that medical ethics and medical deontology prohibit confusing the patient and express themselves in an unnecessarily complex manner, without conveying to the person the essence of his condition. This gives rise to additional fears in the patient, which do not at all contribute to a speedy recovery and can have a very detrimental effect on the relationship with the doctor.

In addition, medical ethics and deontology do not allow the doctor to talk about the patient. Moreover, this rule should be followed not only with friends and family, but even with those colleagues who do not take part in the treatment of a particular person.

Nurse-patient interaction

As you know, it is the nurse who has more contact with patients than other healthcare workers. The fact is that most often after a morning round the doctor may not see the patient again during the day. The nurse delivers pills to him several times, gives injections, measures his blood pressure and temperature, and also carries out other appointments from the attending physician.

The ethics and deontology of a nurse instruct her to be polite and responsive towards the patient. At the same time, under no circumstances should she become an interlocutor for him and answer questions about his illnesses. The fact is that a nurse may misinterpret the essence of a particular pathology, as a result of which harm will be caused to the preventive work carried out by the attending doctor.

Relationships between junior medical staff and patients

It often happens that it is not the doctor or the nurse who is rude to the patient, but the nurses. This should not happen in a normal healthcare facility. Junior medical staff must care for patients, doing everything (within reasonable limits) to make their stay in the hospital as convenient and comfortable as possible. At the same time, they should not engage in conversations on distant topics, much less answer questions of a medical nature. Junior staff do not have a medical education, so they can only judge the essence of diseases and the principles of combating them at a layman level.

Relationship between nurse and doctor

And deontology calls for staff to treat each other with respect. Otherwise, the team will not be able to work harmoniously. The main link in professional relations in a hospital is the interaction between doctors and nursing staff.

First of all, nurses need to learn to maintain subordination. Even if the doctor is very young, and the nurse has worked for more than a dozen years, she should still treat him as an elder, fulfilling all his instructions. These are the fundamental foundations of medical ethics and deontology.

Nurses should adhere to such rules especially strictly in relationships with doctors in the presence of a patient. He must see that appointments are made to him by a respected person who is a kind of leader capable of managing a team. In this case, his trust in the doctor will be especially strong.

At the same time, the basics of ethics and deontology do not prohibit a nurse, if she is experienced enough, from hinting to a novice doctor that, for example, his predecessor acted in a certain way in a specific situation. Such advice, expressed in an informal and polite manner, will not be perceived by the young doctor as an insult or an understatement of his professional capabilities. Ultimately, he will be grateful for the timely hint.

Relationships between nurses and junior staff

The ethics and deontology of a nurse instruct her to treat junior hospital staff with respect. At the same time, there should be no familiarity in their relationship. Otherwise, it will decompose the team from the inside, because sooner or later the nurse may begin to make complaints about certain instructions of the nurse.

If a conflict situation arises, a doctor can help resolve it. Medical ethics and deontology do not prohibit this. However, middle and junior staff should try to burden the doctor with such problems as rarely as possible, because resolving conflicts between employees is not part of his direct job responsibilities. In addition, he will have to give preference in favor of one or another employee, and this can cause the latter to have complaints against the doctor himself.

The nurse must unquestioningly carry out all adequate orders of the nurse. In the end, the decision to carry out certain manipulations is made not by her herself, but by the doctor.

Interaction between nurses

As with all other hospital employees, nurses should behave with restraint and professionalism in their interactions with each other. The ethics and deontology of a nurse instruct her to always look neat and be polite with colleagues. Disputes that arise between employees can be resolved by the head nurse of the department or hospital.

At the same time, each nurse must perform exactly her duties. There should be no evidence of hazing. This especially needs to be monitored by senior nurses. If you overstrain a young specialist with additional job responsibilities for which he will not receive anything, then he is unlikely to remain in such a job long enough.

Relationships between doctors

Medical ethics and deontology are the most complex concepts. This is due to the variety of possible contacts between doctors of both the same and different profiles.

Doctors should treat each other with respect and understanding. Otherwise, they risk ruining not only their relationships, but also their reputation. Medical ethics and deontology strongly discourage doctors from discussing their colleagues with anyone, even if they are not doing exactly the right thing. This is especially true in cases where a doctor communicates with a patient who is seen by another doctor on an ongoing basis. The fact is that it can forever destroy the trusting relationship between the patient and the doctor. Discussing another doctor in front of a patient, even if a certain medical error was committed, is a dead-end approach. This, of course, can increase the status of one doctor in the eyes of the patient, but it will significantly reduce the trust in him on the part of his colleagues. The fact is that sooner or later the doctor will find out that he was discussed. Naturally, after this he will not treat his colleague the same as before.

It is very important for a doctor to support his colleague, even if he made a medical mistake. This is exactly what professional deontology and ethics prescribe to do. Even the most highly qualified specialists are not immune from mistakes. Moreover, a doctor who sees a patient for the first time does not always fully understand why his colleague acted this way and not otherwise in a given situation.

The doctor must also support his young colleagues. It would seem that in order to start working as a full-fledged doctor, a person must study for many years. During this time, he indeed receives a lot of theoretical and practical knowledge, but even this is not enough for the successful treatment of a particular patient. This is due to the fact that the situation in the workplace is largely different from what is taught in medical universities, so even a good young doctor who has paid great attention to his training will not be ready to deal with a more or less complex patient.

The doctor’s ethics and deontology instruct him to support his young colleague. At the same time, talking about why this knowledge was not acquired during training is meaningless. This may confuse the young doctor and he will no longer seek help, preferring to take the risk rather than seek help from the person who judged him. The best option would be to simply tell you what to do. Over the course of several months of practical work, the knowledge acquired at the university will be complemented by experience and the young doctor will be able to cope with almost any patient.

Relationships between administration and health workers

The ethics and deontology of medical personnel are also relevant within the framework of such interaction. The fact is that representatives of the administration are doctors, even if they do not take much part in the treatment of the patient. All the same, they must adhere to strict rules when communicating with their subordinates. If the administration does not quickly make decisions on those situations where the basic principles of medical ethics and deontology have been violated, then it may lose valuable employees or simply make their attitude to their duties formal.

The relationship between the administration and its subordinates must be trusting. It really does not benefit hospital management when their employee makes a mistake, so if the chief physician and medical director are in place, they will always try to protect their employee, both from a moral point of view and from a legal point of view.

General principles of ethics and deontology

In addition to specific aspects in the relationship between various categories, one way or another related to medical activities, there are also general ones that are relevant for everyone.

First of all, a doctor must be educated. The deontology and ethics of medical personnel in general, not just doctors, prescribe in no case to cause harm to the patient. Naturally, everyone has gaps in knowledge, but the doctor must try to eliminate them as quickly as possible, because the health of other people depends on it.

The rules of ethics and deontology also apply to the appearance of medical personnel. Otherwise, the patient is unlikely to have sufficient respect for such a doctor. This may lead to non-compliance with the doctor’s recommendations, which will worsen the patient’s condition. At the same time, the cleanliness of the robe is prescribed not only in streamlined formulations of ethics and deontology, but also in medical and sanitary standards.

Modern conditions also require compliance with corporate ethics. If it is not guided, then the medical profession, which today is already experiencing a crisis of trust on the part of patients, will become even less respected.

What happens if the rules of ethics and deontology are violated?

In the event that a medical worker has done something not very significant, even if it contradicts the basics of ethics and deontology, then his maximum punishment may be deprivation of bonuses and a conversation with the chief physician. There are also more serious incidents. We are talking about those situations when a doctor does something truly out of the ordinary, capable of harming not only his personal reputation, but also the prestige of the entire medical institution. In this case, a commission on ethics and deontology is assembled. Almost the entire administration of the medical institution should be included in it. If the commission meets at the request of another medical worker, then he must also be present.

This event is in some ways very reminiscent of a trial. Based on the results of its conduct, the commission issues one or another verdict. He can either acquit the accused employee or bring him a lot of trouble, including dismissal from his position. However, this measure is used only in the most exceptional situations.

Why are ethics, as well as deontology, not always respected?

First of all, this circumstance is associated with the banal syndrome of professional burnout, which is so characteristic of doctors. It can occur in workers of any specialty, whose duties include constant communication with people, but it is among doctors that this condition occurs most quickly and reaches its maximum severity. This is due to the fact that, in addition to constantly communicating with many people, doctors are constantly in a state of tension, because a person’s life often depends on their decisions.

In addition, medical education is received by people who are not always suitable for work in the world. However, we are not talking about the amount of necessary knowledge. Here, the desire to do it with people is no less important. Any good doctor should be at least to some extent concerned about his work, as well as the fate of his patients. Without this, no deontology or ethics will be observed.

Often, it is not the physician himself who is to blame for non-compliance with ethics or deontology, although the blame will fall on him. The fact is that the behavior of many patients is truly defiant and it is impossible not to react to this.

About ethics and deontology in pharmaceuticals

Doctors also work in this area and very, very much depends on their activities. It should not be surprising that there are also pharmaceutical ethics and deontology. First of all, they are to ensure that pharmacists produce sufficiently high-quality drugs, and also sell them at relatively affordable prices.

It is under no circumstances acceptable for a pharmacist to launch a drug (even in his opinion, simply excellent) into mass production without serious clinical trials. The fact is that any drug can cause a huge number of side effects, the harmful effects of which collectively exceed the beneficial ones.

How to improve compliance with ethics and deontology?

No matter how it sounds, a lot depends on money issues. It has been noted that in countries where doctors and other medical workers have fairly high salaries, the problem of ethics and deontology is not so acute. This is largely due to the slow development (compared to domestic doctors) of professional burnout syndrome, since foreign specialists for the most part do not have to think much about money, because their salaries are at a fairly high level.

It is also very important that the administration of the medical institution monitors compliance with ethical and deontological standards. Naturally, she herself will have to adhere to them. Otherwise, there will be many facts of violation of the rules of ethics and deontology by employees. In addition, in no case should one demand from some employees something that is not fully demanded from another.

The most important point in maintaining the team’s commitment to the basics of ethics and deontology is periodic reminders to medical personnel of the existence of such rules. At the same time, it is possible to conduct special trainings, during which employees will have to jointly solve certain situational problems. It is better if such seminars are not held spontaneously, but under the guidance of an experienced psychologist who knows the specifics of the work of medical institutions.

Myths of ethics and deontology

The main misconception associated with these concepts is the so-called Hippocratic oath. This is due to the fact that in disputes with doctors, most people remember her. At the same time, they indicate that one needs to be more compassionate towards the patient.

Indeed, the Hippocratic Oath has a certain relationship to medical ethics and deontology. But anyone who has read its text will immediately note that it says practically nothing about patients. The main focus of the Hippocratic Oath is the doctor's promise to his teachers that he would treat them and their relatives free of charge. Nothing is said about those patients who did not participate in his training in any way. Moreover, today not all countries take the Hippocratic oath. In the same Soviet Union, it was replaced by a completely different one.

Another point regarding ethics and deontology in the medical environment is the fact that patients themselves must follow certain rules. They need to be courteous to all levels of medical personnel.

Introduction

The psychological characteristics of the patient in the conditions of therapeutic relationships and interaction come into contact with the psychological characteristics of the medical worker. In addition, the persons involved in contact with the patient may be a doctor, psychologist, nurse, or social worker.

In medical activities, a special connection is formed, a special relationship between medical workers and patients, this is the relationship between a doctor and a patient, a nurse and a patient. According to I. Hardy, a “doctor, nurse, patient” connection is formed. Everyday therapeutic activities are connected in many nuances with psychological and emotional factors.

The relationship between doctor and patient is the basis of any therapeutic activity. (I. Hardy).

patient medical doctor

Doctor-nurse relationship

The doctor and nurse are a dominant couple, influencing all processes in the department that affect patients.

Nurses communicate with patients throughout the day and are called upon to create a therapeutic and protective regime, without which recovery is impossible.

In a healthcare facility, the patient necessarily experiences physical and mental discomfort, which is associated both with the treatment process and with service and communication.

Modern trends are such that old stereotypes are gradually changing; the nurse, now, plays the role of a real assistant to the doctor, his assistant and partner.

In principle, the nurse’s participation in the treatment process can be viewed from two perspectives:

• 1. The nurse performs auxiliary functions, supports the work of the doctor, acts proactively, as a team player, is result-oriented, worries about the patient, is fully involved in the therapeutic process, as a necessary and responsible link.
• 2. The nurse maintains a passive, detached type of relationship with the patient, does not worry about the outcome of treatment, does not feel responsible, requires constant monitoring by the doctor, carries out the doctor’s orders literally, “for show,” often not in full.

What are the possible principles of mutual behavior in the doctor-nurse system?

1) The principle of clear separation of functions.

When the responsibilities of a nurse are clearly regulated and strictly defined, they do not overlap with the responsibilities of a doctor. A case where a doctor has taken over the scope of a nurse’s work, or a nurse has “intruded” into the doctor’s area of ​​competence, is considered as an encroachment on the colleague’s area of ​​competence. This approach is possible, but poses certain threats. It leads to the fact that the nurse does not feel responsible for the result of treatment as a whole, which gives her the opportunity to withdraw from therapeutic tasks as such, and engage only in mechanical work.

Often the behavior of such a nurse is formal and indifferent, she is not involved in psychological reassurance of the patient, his information support, the patient fixes her in his mind as a kind of shadow, a girl in a mask who silently and thoughtlessly carries out the procedures prescribed by the doctor.

When a patient asks: “What does this injection help with?”, the answer usually follows: “Ask the doctor, he prescribed it!”

2) The “bring and serve” principle.

This principle is based on a clear functional limitation, that is, the nurse, from the entire range of her duties, performs only those indicated by the doctor.

This principle is even more imperfect than the previous one. In fact, he completely relieves the nurse of responsibility for his actions, since the doctor is responsible for everything.

The nurse is responsible only for the quality of the assignment completed, and even then only to the doctor, and not to the patient.

The principle “do what the doctor says” devalues ​​the nurse’s experience and blocks the initiative and independence of her thinking.

The nurse's attempts to advise the physician usually lead to conflicts.

3) The principle of partnership.

The modern ideology of healing should be built on the principles of partnership and mutual assistance.

The nurse must have some independence. Of course, she should not independently write out the medical prescription chart, but she should be able to independently vary her behavior depending on the situation.

Often the doctor is simply unable to approach a patient who has become worse; he may be on an urgent call or carry out resuscitation measures. In this case, the nurse is obliged to correctly assess the situation and provide maximum assistance.

In addition, the nurse should try to play an active role in the fate of the patient, this includes moral and informational support, and calling the patient’s relatives if necessary.

Within the framework of this principle, the nurse must behave actively. Of course, its activity should not be excessive. For example, some nurses like to engage in dialogue between the doctor and the patient and give certain advice, this, of course, needs to be stopped by explaining to the nurse that extra advice never hurts, but it should be given in private, and not in the presence of the patient, and even by interrupting doctor

Ideally, the nurse should work in “anticipatory reflection,” that is, interact with the doctor as if she were reading his next action, or order, without words.

Also, the nurse must be proactive, which can be manifested in the search for improvement of their manual operations, a certain resourcefulness and speed of work.

Of course, the introduction of these principles into work automatically raises the status of the nurse, not just a performer, but a doctor’s assistant.

A nurse as a physician's assistant will be able to act more actively and create comfortable conditions for both colleagues and patients.

For a doctor-nurse pair, it is very important to be “working well together”, that is, to profess a style of joint activity that leads to achieving good results without wasting extra energy.

Often, when nurses are on duty according to their own schedule, and a doctor is on duty according to his own, then couples go on duty who do not match for one reason or another (temperament, upbringing), and, as a result, work suffers.

Teamwork between a doctor and a nurse also has a negative side, when this cooperation is comfortable only for the participants in the treatment process, but not for the result of the therapeutic process. In other words, the doctor “doesn’t strain” the nurse, the nurse rarely “pulls” the doctor, that is, both work at half capacity. This type of interaction does not lead to improved therapeutic results and negatively affects the reputation of the department. A competent manager must break such alliances in a timely manner.

Real synergetic work is the level of partnership interaction when 1+1=3, but not 1.5.

In the process of interaction, it is very important to trust each other. Professional trust is the foundation of synergistic interaction.

Often nurses, especially those with extensive work experience, do not trust doctors’ orders; in addition, they like to give public assessments; they can be driven by personal hostility towards a colleague, resentment, unrealized life opportunities, etc.

It should be customary in the team not to encourage such statements, but this can be very difficult to do, especially if such assessments are “protected” by the head nurse.

Usually, a lot depends on the senior nurses, and even more depends on the tandem of the head of the department - the head nurse; if this pair follows a constructive policy, then, as a rule, there is a good atmosphere in the department.

It is very important to understand such aspects as the interdependence of the doctor and the nurse and the focus on achieving a team result.

Often experienced nurses skillfully manipulate doctors, they learn to demonstrate initiative, devotion and caring, while at the same time showing humility and submission to the doctor's authority. Such nurses often lead doctors to certain decisions, so that the doctor thinks that this decision is his own; this does not undermine the doctor’s authority and allows him to avoid conflict situations. Often these nurses are very successful.

There is another type, which can be called “silent saboteurs”, who do not scandalize or become indignant, but at the same time it is very difficult to force them to do anything.

There is a “protesting type” of nurses who have difficulty in the process of compliance and are often unwilling to come to agreement while providing medical care to a patient. They often tend to make angry and accusatory speeches that tend to be inconsistent with the intensity of the triggering event.

For a doctor, respect for nurses is a very important thing. The point is not only that this facilitates and improves the therapeutic process, but also that a nurse who respects a doctor is your walking advertisement for patients; discreet praise of a doctor by a nurse has a magical effect on patients. I have sometimes observed situations where doctors, accepting private patients, sought to earn more (not shared with the nurse) and independently took ECGs, took blood, etc. This is a short-sighted policy, if you want the patient to truly become “yours”, not It’s worth saving on it, let a nurse who respects you take care of it.

What practical actions can a doctor take to strengthen his authority among nurses?

• * You need to know all the nurses by name; if there is a “new girl” in the department, introduce yourself to her, she will really appreciate it and remember it.
• * Become “your own” in the “sister room”, allocate time for them (of course, within reasonable limits), listen to their problems.
• * Be aware of changes in their roles and responsibilities (know who is filling in for the head nurse)
• * If you are not on duty at night, choose a time and work several night shifts; night shifts bring you closer together.
• * When giving instructions, soften them in the form: “Please enter”, “Could you check.”
• * If there is a difficult task ahead, and there are several nurses, then instead of the directive choice “Will you do it,” it is better to ask “Who will take it?”
• * If you notice the first signs of irritation, do not let the wound fester; it is better to immediately ask in private, “What’s the matter?”, and be prepared for criticism.
• * Create a culture of relationships that encourages all team members to contribute as well as openly express their views.
• * Be prepared to share the work if a critical situation arises.
• * Take risks if a dangerous situation arises.
• * Support and recognize nursing excellence and communicate this to management.
• * Be prepared to support nurses in both life and work.
• * Maintain a good relationship with the charge nurse.
• * Participate in informal department meetings, do not ignore the nursing community, raise a toast to them...

How a newbie should behave.

The appearance of newcomers, be they clinical residents, or interns, or novice doctors, is perceived by nurses as an extra headache.

Almost all newcomers are yesterday's university graduates, still new to practical work, the only exceptions being those who previously worked as a nurse or paramedic.

Particularly suitable for interns and clinical residents are medical institutions that have departments in various specialties.

Why do newbies bother nurses so much?

First of all, with irrepressible enthusiasm and desire to introduce new trends into the healing process. True, most cool down after about half a year. Often this enthusiasm manifests itself in a huge number of appointments and examinations, which are extra work for nurses. Doctors are often younger than nurses, which exacerbates disagreements.

Often a newcomer overestimates his strength and takes on an overwhelming amount of responsibility.

In addition, nurses are better versed in practical algorithms when emergency situations arise.

Due to the newcomer's fault, nurses are often stressed and demand compensation by voicing their dissatisfaction to colleagues and management.

It’s generally not easy for a newbie to start working. As a rule, he is the center of attention; none of his colleagues show it, but they watch him very closely.

A newcomer needs to behave with restraint and tact, not to be servile, but not to be arrogant. Helping nurses in “hot moments” in the department is very useful for future relationships.

Also, informal events, various holidays, and birthdays should be used 100% of the time.

Thus:

• * The role of the nurse in modern medicine is changing.
• * The ideology of interaction should be based on the ideas of professional partnership.
• * The level of therapeutic results depends on the collaboration between the doctor and the nurse.