Culture of Medicine

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

Clinical Scenario
1. Yes, I agree with the attending. It is doctors prerogative to conceal a mistake 2. No, I do not agree with the attending. Doctors are obliged to disclose medical errors.

Background
As medical students proceed through the clinical rotation at medical school, they meet tremendous challenges to their professional development The "culture of medicine" on the wards and in the clinics takes its toll on our students

Background
Most students survive these threats to their well being and become acculturated to the world of medicine, albeit, often with residual feelings of anger, resentment and hostility Others go on to perpetuate the same practices on those trainees more junior

Background
In an effort to make the experience of clinical rotation more humane, and allow for discussion and reflection, new policies and educational programs will be developed at UGM

Culture
(Merriam-Websters Collegiate Dictionary)

a. The integrated pattern of human knowledge, belief, and behavior that depends upon man's capacity for learning and transmitting knowledge to succeeding generations

Culture
(Merriam-Websters Collegiate Dictionary)

b. The customary beliefs, social forms, and material traits of a racial, religious, or social group

Culture
(Merriam-Websters Collegiate Dictionary)

c. The set of shared attitudes, values, goals, and practices that characterizes a company or corporation

Culture of Medical School

Adjusting to the Culture of Medicine

In addition to acquiring a great deal of knowledge, your years in medical school are an intense process in acculturation The culture of medicine has its own norms, rules and expectations

Adjusting to the Culture of Medicine

Much of this culture is imparted through the hidden curriculum: what students learn by observation of role models Often this new behavior is incorporated without thinking Self-reflection and discussion with others can help you to consciously process the hidden curriculum so that you have a choice about the behaviors you adopt

Adjusting to the Culture of Medicine

There are four categories of acculturation:
1. Integration occurs when a student maintains an active interest in both the culture of origin and the new culture (medicine) 2. In assimilation, a student concentrates on the new culture but has no interest in the native culture

Adjusting to the Culture of Medicine

There are four categories of acculturation:
3. Separation occurs when a student focuses on the culture of origin while being uninterested in the new culture 4. Finally, marginalization represents the attitude of a student with no interest in maintaining or acquiring proficiency in either culture, native or new

Adjusting to the Culture of Medicine

Take a moment to think about where you are in the midst of your acculturation journey and how it affects your well-being For first-year students, the lack of elder students to guide you through the new curriculum may wear on your resilience

Paternalism
(Merriam-Websters Collegiate Dictionary)

1. A system under which an authority undertakes to supply needs or regulate conduct of those under its control in matters affecting them as individuals as well as in their relations to authority and to each other 2. A policy or practice based on or characteristic of paternalism

Culture of Medicine and Medical Error

The culture of medicinewith its emphasis on professional autonomy, collegiality, and selfregulationis unlikely to foster the reporting of mistakes Moreover, the organisational culture of the NHS, with its emphasis on blame, and an increasingly litigious public may only serve to exacerbate the problem (Lawton and Parker, 2002)

Culture of Medicine and Doctor-Patient Relationships

Medicine is expert centred Medical culture tends to maintain patients' dependence and childlike compliance by means of power and control, labelling, and treating, which often distance the patient from the expert Medical culture often maintains mystique by using jargon and withholding information (Menage, 1997)

Culture of Medicine and Preventive Services

Clinical preventive services, such as screening tests, immunizations, and behavioral change counseling, should be a key component of the shift away from a reactive, disease-oriented medical culture toward a proactive, health-based one But many of these services, studies show, are being honored more in the breach than in the observance (Reynolds, 1998)

Culture of Medicine and Medical Education

Deficiencies in education about end-of-life care are widely recognized, both in the formal or structured curriculum, and in the informal curriculum (the culture in which students are immersed as they learn medicine) (Block, 2002)

Another cultures of medicine

Evidence-based medicine American Doctor Patient Disease-oriented Others

Resolution of the clinical scenario

An ethical dilemma. Medical errors and medical culture. BMJ 2001;322:1236-40. 1236.pdf

Whistleblower
There are many reasons why doctors remain silent in similar situations, though two in particular have impeded openness in the past:
Firstly, the culture of medicine has been one in which you shouldn't let the side down, and in which whistleblowing is seen as sneaking on your colleagues Secondly, confidentiality clauses in NHS trust contracts effectively gagged employees

But the culture and the law are changing