Iranian Journal of Medical Ethics and History of Medicine

The most important factor in interpersonal relationships is trust. Trust in the physician-patient relationship is key and essential. Understanding the factors that affect trust is a prerequisite for trust. These factors vary in different societies. So we need to identify these factors and provide a single criterion for measuring them. Therefore, because we need a tool to measure these different factors in the context of culture and society, the purpose of this study is to determine the factors that influence public confidence in physicians to provide the necessary evidence for making appropriate instruments in Iran. The first step was to investigate the factors affecting patients' confidence in physicians during a library study. Then, during interviews and numerous discussion sessions, nineteen factors influencing public confidence in physicians were provided. Then, to determine the content validity, twenty experts evaluated the transparency, relevance and importance of the factors. Content validity ratio (CVR) and content validity index (CVI) were measured. CVR value for each of nineteen factors was 0.42, therefore content validity of the tool was significant with P.value 0.05. CVI value was 0.944 and content validity of the tool was confirmed. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study and can be used as factors for assessment of public confidence in physicians. Factors affecting public confidence in physicians in Iran include 19 factors extracted during this study.

The concept of Islamic medicine, which differs from traditional medicine and even Muslims’ medicine, has become more and more popular in recent years in Iran, especially in religious cities. In the present article, we have addressed the extremist approach of the claimants of Islamic medicine (which considers itself a competitor of modern medicine and traditional medicine).Our theoretical basis for the ethical criticism of this approach has been the principlism of "Beauchamp and Childers". Thereby, we have attempted to challenge the clinical position and medical performances of extremists in the Islamic medicine on the basis of four principles of "justice, autonomy, beneficence, and non-maleficence". Then, we have concluded that the claim of the Islamic medicine cannot, in the present circumstances, satisfy the principle of distributive justice. It also violates patients' autonomy by making unfair judgments and fears about modern medicine. It is very prone to harm clients by refusing scientific evaluation of medicines and therapies and lacking a valid certification system.  Accordingly, we  particularly challenged the attribution of this process to Islam.  This attribution may cause serious damage to the religious beliefs of the clients.

Adherence to professional ethics based on spiritual intelligence is conducive to patient welfare and satisfaction. The purpose of this study was to determine the relationship between professional ethics and spiritual intelligence of Kerman University of Medical Sciences' students. In this descriptive co relational study, 150 undergraduate medical students were enrolled in the census. The tools used were spiritual intelligence and professional ethics questionnaires. Data were analyzed by SPSS version 22 using independent t-test, one-way ANOVA, and Pearson correlation coefficient. The mean and standard deviation of professional ethics score was 57.72±6.2 and the spiritual intelligence of students was 73.97±12 12.3. The lowest score of professional ethics was in the area of ​​responsibility and the most in sympathy with others. There was also a significant positive relationship between professional ethics scores and students' spiritual intelligence (P = 0.001). This means that by educating and enhancing students 'spiritual intelligence during their studies, one can expect to increase students' professional ethics during clinical work and professional communication with the patient. To this end, teachers' emphasis on aspects of ethical applied education, especially during clinical education, as well as honoring spiritual patterns as the foundation of ethical education during college education seems necessary.

Medical error is one of the most important ethical and legal issues that sometimes occur when a variety of health care practices are provided by healthcare professionals. Due to the necessity of medical error disclosure and lack of adequate personal and organizational support in this field, this study investigates strategies for facilitating error disclosure as well as increasing the variety of supportive measures from the perspective of residents. This was a descriptive cross-sectional study with statistical population including all residents of Shiraz University of Medical Sciences. The sample size was obtained using Morgan table as 248 participants. Data were collected using a researcher-made questionnaire (with descriptive and valid reliability) and analyzed by SPSS software using descriptive and inferential statistics. In this study, increasing support facilities for medical error disclosure (mean 4.38) was the most important factor, and increasing the lawfulness and transparency of activities in the medical setting (mean 4.32) was the second factor affecting the promotion of medical error disclosure. Also, medical liability insurance (mean 4.80) was the most important supportive measure. The fear of legal and judicial consequences was reported as the most effective factors on the error concealment and having experienced lawyers and cultivation effects of mass media declared as the way out. In the present study, although most residents agreed with medical error disclosure, but due to the wide range of risk management problems that affect error disclosure, they found it necessary to establish a support system. Given the teamwork in health-care delivery, support should be given to all members of the treatment team.

The Zebrafish is a preeminent model organism that, with its most prominent features, has expanded the boundaries of science in many disciplines. Characteristics of this small freshwater fish, with the help of biologists, showed that it has a highly comparable genetic with mammals such as mice and rats. For example, the emergence of new and efficient methods for duplicating and editing the genome has helped to increase the growth of its use in various fields of science, including toxicology, drug discovery, transplant biology, disease modeling, and even aquaculture. Continued maturation and adoption of the Zebrafish model system require the improvement of methods and approaches for the cultivation and management of these fishes in controlled reservoirs, so that, ultimately, research on this fish is more reusable, cost-effective and in a framework for ethics in research. Knowledge and technology transfer from laboratory science, medicine, and aquaculture is a necessary part of this development, which should be in line with ethical standards in science. In this paper, we would consider the ethical and technical principles of working with Zebrafish as a species model in studies of medical sciences.
 

Medical errors in pediatrics if different from adults. This study aimed to investigate type and frequency of medical errors and the related contributing factors from pediatric residents' point of view. This descriptive and cross sectional study was done in 2016. After determining validity (face and content) and reliability the final questionnaire with 17 questions categorized in six parts was used for data collection. Data were analyzed descriptively using SPSS v.22. ''Errors of diagnosis or delay in diagnosis' (8.6)', ''choosing appropriate dose (8.3) and medication (8.2)'' had the highest average weights. Fellows of pediatrics (12.6) and pediatrics’ professors (12.1) with the highest average weights had the most dominant role in diagnosis and prevention of errors. The most and the least average weights of the errors was reported for urban general physicians and pediatrics’ professors, respectively. Errors could occur at 2-8 AM more likely. Junior residents were the ones with the most chance of doing errors. Medical errors were mostly reported to occur in the group of children (70.6%) than neonates (29.4%). Reconstruction and strengthening educational and supervision role of pediatric fellowships and attending with the aim of in time diagnosis and then prevention of medical errors could be considered as a must in teaching hospitals. Holding purposeful educational courses and control of contributing factors like workload, exhaustion, inexperience, etc. are among duties of educational and executive managers.
 

According to the important role of family factors in people quality of work and the importance of correct emotional relationship of medical staff in patients' satisfaction and spirits, the aim of the present study was to investigate the relationship between perceived intimacy from the main family and work-family conflict with empathy and addiction to work in the medical staff. This study was a description of correlation type. The statistical population of this study included all the medical staff of medical centers in Bojnourd city in the 2018-19 year. Among them 250 person were selected by available sampling method. For data collection we used main family health Questionnaire, work-family conflict questionnaire, Lamonica empathy scale, and work addiction questionnaire. To analyze the data of this study, Pearson correlation coefficient and regression analysis were used. In order to analyze the data, SPSS software (version 25) was used. The results of Pearson correlation showed that perceived intimacy from the main family had a positive and significant correlation with empathy and negative correlation with addiction to work. Also, the results indicated that there is a significant correlation between work-family conflicts with empathy, but there was not a significant correlation between work-family conflicts and addiction to work. The results of the present study indicate the role of family system and its internal conflicts on empathy with patients and work addiction in hospital staff, which emphasizes the need to pay more attention to the improvement of quality of family life of health care staff.

One of the main methods of improving patient safety is use of reporting systems and providing facilities for analyzing and preventing mistakes. The aim of this study was to determine the attitude of nursing managers of hospitals affiliated to Kurdistan University of Medical Sciences towards the voluntary reporting system of medical errors in 2015. In this descriptive-analytic study, all managers of selected hospitals in Kurdistan province were enrolled in this study. The data was collected through a valid questionnaire for attitude towards the voluntary reporting system of medical errors. Data were analyzed by SPSS software version 20, independent t-test, chi - square and ANOVA. According to the results of the study, 87.9% (80 participants) of the managers encountered reporting of errors in their workplace. 68.1% (62 participants) of the managers had a positive attitude toward the voluntary system of medical errors and 16.15 % (15 participants) had a negative attitude and 15.38% (14 participants) were indifferent. According to the results of the research, more than 68.1 % of managers have a positive attitude towards the voluntary reporting of medical errors and with the necessary measures a suitable platform for launching the voluntary reporting system of medical errors in the treatment centers can be provided.

Over the past years in the literature of medical ethics about the doctor-patient relationship, patient's rights have been greatly considered, but the other side of this relationship is not concerned, and the physician’s obligations have been highlighted. The two meanings are understood from the concept of   physicians’ rights; their rights in conflict with the patient rights’ and the right to self improvement. We want to review the causes of this neglect and its complications. The reasons for not paying attention to the physician’s rights include: traditional beliefs about the power imbalance in doctor-patient relationship, lack of emphasis in the four principles of medical ethics, lack of supportive structures, customer-orientation in medicine, and hyper medical professionalism. Continuing this neglect creates complications that include: physicians’ work-life imbalance, symbolic violence in their society, burnout of physicians, forgetting the principle of gratitude and ultimately, the lack of respect for patients' rights. Consequently, the discourse of medical ethics fails to achieve its primary goals.

The criminal responsibility of physicians and assistants is a complex area of ​​medical law. The purpose of this study was to investigate the responsibility of medical residents and medical students in performing diagnostic and therapeutic measures with case study of forensic medical files in Fars province from 2012 to 2017. In this study, 63 plaintiffs' cases were assessed, including 33 males (52.4%) and 30 females (47.6%). Most of the complainants were illiterate and under-graduate, and the least frequent was at doctoral level. Regarding the physical condition of the plaintiff (patient), the highest frequency was related to death ( 73%). Most of the complaints were from treatment group (95.2%) and physicians (4.8%). In terms of field of study, the field of obstetrics and gynecology (44.4%) included more complaints than other fields. In total, 26 (41.3%) cases were finally acquitted and 37 (58.7%) were convicted. The most common type of failure was neglect (91.9%). In this study, the highest frequency of associate education was related to senior resident (11.1%). Based on the results of the present study, medical errors were made by trainees (interns) and residents, specifying the criminal responsibilities of medical students and residents for errors and omissions and explaining their findings. Educational materials in each course are of particular importance. Additionally holding forensic courses and defining the legal and criminal responsibility for medical students are important for the improvement of treatment quality
 

Writing treatises and books on ethics and morality is one of the most important topics in medicine history. Teaching and learning medical knowledge and skills was a common one in the golden age of science in Islam, too. The scholars of that period considered the ethical points of view as an important fact in their medical profession. The present article reports the behavior and ethics of physicians based on the review on the first book in this field, "Adab al-Tabib". This book, which can be called the Encyclopedia of Medical Ethics, represents standpoints of the prominent Islamic scholar, Ishaq bin Ali Al-Ruhawi. In this paper, it was intended to summarize the main points of professional behavior and ethics among physicians. Due to the wide-ranging and comprehensive nature of the book, only a few pertinent topics were reviewed. Those topics include the necessity and concept of politeness; the behavior and commitment of physicians towards themselves, patients and society as well as the behavior of nurses, attendees and tips on how to train and examine medical and pharmacy students. Al-Ruhawi in this book, declares that the first necessity of medicine is the true faith and belief in God and the doctors are the guardians of the body and soul. Commitment to medical education, nurses and pharmacists’ role in the management process, physicians’ communication skills suggesting of learning other sciences such as philosophy and more important point, strong relationship of body and soul, are the strengths of Adab-al-Tabib that Ruhawi intended to improve quality of medical services by reviewing them.
 

One of the main issues in hospitals is evaluation of efficiency and effectiveness. For this purpose, several indicators are presented, which are known as functional indicators. If the performance of hospitals depends on the patient's demographic characteristics, overlooking effect of hospital indicators, as an effective factor at a higher level on the patient rights, may lead to inaccurate conclusions about these relationships. In such cases, where the data are intrinsically multilevel, the use of multi-level statistical models for this type of data is useful. Samples were collected from eight hospitals of Tehran University of Medical Sciences during 2013 in a two stage cluster. Data on patient rights and demographic information were collected from 375 patients by a questionnaire. The patient's rights rate was measured by multivariate statistical analysis and factor analysis. Two-level linear regression models were used to examine the relationship between patients' rights and some demographic information. The first level was demographic factors and the second level was hospital factors. The results showed that rate of considering patients' rights in hospitals were in moderate level. About 16% of the variance of the dependent variable of patient's rights, which was significant, is due to variations at the higher level of the hospital and other variations at the individual level. Furthermore, variables of bed occupancy, complaint rate, and hospital escape rate at the higher level (Hospital) have a significant impact on the patient's rights.

The possibility of mistakes, negligence, injuries and damages in medical activities could give rise to a civil or criminal case. In such cases, resorting to experts’ opinion is necessary. Forensic medicine organization has important role in such cases. Therefore, understanding of the criteria used by experts of this organization is important and could give rise to awareness of doctors and reduce their professional failures. This is a practical research with a descriptive and analytical method and its necessary information are collected by documentary studies. This investigation shows that medics normally try to have correct medical diagnosis and select appropriate process, and treat patients through reasonable methods to reduce their suffering and pains. It is possible that medics make a mistake in their diagnosis and treatment. Although the result of medical treatment are not guaranteed always, they have to do their treatment and operation according to reasonable and scientific standards and any recklessness and negligence causes criminal or civil responsibility. Reflection on the medical cases shows that the reasons of medic’s conviction can be divided into two categories including pre-treatment and post-treatment factors. Pre- treatment indices contain errors related to diagnosis or choice of treatment.

The purpose of this research is to investigate association between social influence, productivity, and performance among researchers of medical ethics field.  This research was done using common methods in scientometric studies with the method of co-author and network analysis. The statistical population of the study consists of all articles published in journals in the field of medical ethics, which were indexed in the database of web of science in the period of 1978-2017. A total of 14,231 articles and 20,845 researchers were surveyed. Data analysis was done using UciNet and SPSS softwares. Research findings based on the social influence that calculated for each researcher. The study of relationship between social influence and performance showed that there is positive correlation between performance and degree centrality. However, there is a negative correlation between performance and closeness and betweenness centrality. Also, the relation between social influence and productivity showed that there is a positive and significant correlation between social influence and productivity indices. The results showed that the researcher who have a good status in terms of performance, have a high social impact. In addition, researchers who have a high degree centrality are in a favorable position in terms of productivity and performance.

In human communication, the relationship between the patient and the physician is one of the most challenging issues. This relationship is of critical importance in the medical ethics and forms the base of medical measures. Relationship between the physician and the patient brings about mutual trust between them to the extent that it overshadows physician’s skills. A physician needs to have the art of communication with the patients as well as his information in medical sciences. Damaging this communication leads to lack of efficiency, trust and satisfaction in the treatment of the patient. The authors of this article seek to analyze the major issues of medical ethics in the medical texts based on Mathnawi. Rumi has also made special mention of physicians' responsibilities and ethical duties in the stories of pulmonology, physiology, herbal therapy, routine treatment, and etc. In The story of “King and Handmaiden”, Confidentiality, Compassion, Kindness, and the expertise of saint against Handmaiden are issues that they are discussing in medical ethics. At the end of the story, audiences unbelievably are evaluating the performance of saint as opposed to the spirit of Hippocratic oath. In the story of “the old man and the physician”; deficiency of the communication between physician and patient is very definite. Not building trust and emotional communication in the relationship between the physician and the patient, specifically at the very first time which has happened without semiology has provided the context in which the patient distrust his physician and is not pleased with the treatment process. In the story of “Man who was desperately ill”, the physician has hidden the secret and also he has not given a clear and enough explanation for the prescription, therefore the patient's life is endangered.
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The physicians of the Bukhtishu dynasty first entered the Abbasi court with the aim of practicing medicine; but soon after, thanks to their medical knowledge and skills, they gained a lot of power and wealth and became involved in power relations at court. Although they were able to gain a high position in the Abbasid court; but their position was constantly unstable, and sometimes they were at the peak of power and sometimes at the bottom of humiliation. Therefore, the present study, with a historical method and a descriptive-analytical approach, seeks to answer the question: what factors have been effective on the relationship between the physicians of the Bukhtishu dynasty and the Abbasid Caliphate? The claim of the research is that the need of the caliphs for treatment provided the background for the entry of the doctors of Bukhtishu dynasty to the caliphate system and strengthened their presence in the court. Factors such as the success of these physicians in medicine, the power of the caliphs in supporting them; other threats from courtiers also fluctuated the status of these physicians. The findings of the study indicate that physicians with the benefit of medical knowledge had such an effect on the caliphs that they were considered as one of the main actors in politics, so they play an important role in the removal and installation of caliphs, poisoning and killing of them. They could pave the way for their conditioned person to come to power by abandoning their treatment; they were also degraded, imprisoned, and sometimes exiled or even killed. 

 Efforts of the medical staff are to provide efficient, desirable, and high quality services to patients. However, medical treatments are not immune to error and mistake. So, occurrence of injury following medical managements is inevitable, an issue that could lead to a lawsuit against the medical staff. In such cases, resorting to experts’ opinion is necessary. Therefore, knowledge about effective indicators in sentencing can increase awareness of the treatment staff in addition to reduction of traumatic behaviors. Reflection on the medical forensic cases shows that the reasons of medic’s conviction can be divided in two categories including pre-treatment and post-treatment factors. Errors after entering the treatment process indicate post-treatment index. Breach at the end of treatment, not doing (lack of) treatment in the appropriate place, mismatch or mistake of used techniques, and fault or blunder are the most important issues related to this index. The present study intends to examine the effective criteria in sentencing medical staff in a descriptive-analytical manner based on expert opinions’ of medical malpractice cases.

This study seeks to identify one of the pioneers of traditional clinical medicine named Abdullah Azdi and his medical dictionary. This research is an analytical study. The focus of the search was on two keywords, Abdullah Azdi and Kitab al-Ma'ma, but the scope of the search included all appropriate terms such as: medicine, Bu Ali Sina, traditional medicine, medical dictionary, ethics, and medical law. Data were collected and analyzed using comprehensive library software (version one), Islamic History Library, Islamic Iran History and reputable national and international centers. The main purpose of the forthcoming research, on the one hand, is to identify and introduce points about life and beliefs, as well as Abdullah Azdi's specialized knowledge in the field of medicine, and on the other hand, to introduce his book, which is in fact a dictionary called "Kitab al-Ma'a". The researches of this research show that Abdullah Azdi was one of the students of Ibn Sina and the companion of Abu Rihan al-Biruni. In addition of being expert in clinical medicine, he was an ethical and professional physician and in every part of his book, he observes the Shari'a. The use of specialized medical terms indicates that he was surrounded by medical knowledge.