Iranian Journal of Medical Ethics and History of Medicine

Trust is one of the most important issues in patient-physician relationship and affects the treatment acceptance and followup from the patient and optimal outcome. Patient trust to emergency physician is different from other physicians in many ways because of patient’s urgent situation and lack of choice in physicians. This paper explores the reasoning for (dis)trust in emergency physicians in Imam khomeini hospital. A qualitative study in Imam khomeyni hospital was done including 5 recorded focused groups (with 3-6 patients in each group) and 8 in-depth interviews with patients. Patient trust’s issues were divided into 2 major groups: 1- issues that depend on emergency physicians (including professionalism; practical skills and physician’s personal factors) 2-issues independent to emergency physicians (including patient’s previous beliefs; environmental and hospital’s factors and patient’s personal factors). Many factors about emergency physicians like personal factors that are extracted from this study were similar to other physicians. In other hand, it seems that patient trust in emergency physicians is affected by environmental factors especially hospital related factors and it is better to consider it as an integrated foundation and not only trust between persons.

Since 1984, criminal law more than any other period has been specified under the framework of human rights and consequently limited based on its principal. It was followed by the emergence of a new approach called “quality of law principle”. In criminal law, which was presented by European Court of Human Rights for the first time then in the content of verdicts issued by this international judicial institute and reconsideration of criminal law legality principle, it has developed and become more consistent with social justice and manners. According to this principle, the qualitative law is a law which is consistent with quality elements of law based on human rights and moral principles. It is interesting to note that lack of each requirement voids the related law and according to Court’s case law, the existence of such law would not be different from lack of law. In present paper, through the investigation of physician liability and focus on article 495 of Islamic Penal Code as the key to legislation in this regard, and given the requirements of quality of law principle, it has been concluded that the above mentioned provision and all other articles related to this context are not consistent with elements of “the Quality of Law”, thus with failure to meet the minimum criteria of justice, social morality and human rights, the law fails to have the required quality and consequently, it is recommended to legislate based on the criteria of Quality of Law.

In this research, an intercultural comparison between medical students from Iran and England was made to investigate the potential impact of culture on empathy and the relationships between empathy and child birth order in the family. The population consisted of medical students of medical universities from three cities: Tehran (Iran), London and Sheffield (England). The sample consisted of 182 students from two countries (88 Iranian, 94 English) which was selected by convenience sampling method. Data was collected by scale of empathy- student version and researcher made demographic questionnaire. Data was analyzed by using student’s t- test, MANOVA and Scheffe post hoc test. Results showed that the physician empathy of Iranian medical students is significantly higher than English students (P <0.01). Also the results showed that birth order of students has a meaningful correlation with their empathy (F=2.96,P<0.05). The results of multivariate analysis of variance showed that in the empathy variable, empathic care and self-care is more than English students rather than the patient of Iranian students, but they do not differ in the component of adopting the view. The result of this study reveals the importance of cultural differences and family factors such as birth order on personality factors for instance the physician ability to empathize with patients.
 

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.

Physician- patient communication is essential for good medical practice and leads to patient satisfaction and subsequent following of prescribed therapeutics and health promotion. There is limited study on this subject in Iran. The purpose of this study was to evaluate patients' satisfaction of the physician-patient communication and factors influencing it to provide useful information for decision-makers within the health services. This research was an applied field cross-sectional study among hospitals in Tehran. Satisfaction was assessed by 22 questions after obtaining consent from the patients. The level of patient's satisfaction with physician's communication among 1200 patients in order of priority was: medium 63.4%, high 15.1%, low 14.4%, very high 4.7%, and very low 2.5%. Mean patients’ satisfaction was 76.35±13.99, maximum and minimum satisfaction was 110 and 30, respectively. There was a significant relationship between patient satisfaction and patients’ gender, age, marital status, occupation, physicians’ age, sex and timely presence of the physician in the clinic and good deal of communication between patient and physician’s receptionist. Overall patient satisfaction with the patient -physician communication is medium that is not desirable. Factors such as gender, age, material status, and occupation of patients and age and sex of physician, timely presence of the physician in the clinic and a good deal of communication between patient and physician receptionist had a positive correlation with patient's satisfaction. According to important role of communications’ skills in patients’ satisfaction, it is necessary to put more emphasis on training and assessment of communication skills of physicians and health care personnel.
 

The mutual trust in a social relationship is essential to adjusting that relationship under ethics and law. The functionality of legal and ethical rules can be trusted to create a good, orderly and just relationship when the parties can trust each other under the protection of such rules. The first legal documents in Iran required the practitioner to obtain the respect and trust of the society in himself and his colleagues, and then made clear his obligation under it. In subsequent reforms, such obligation stood as they were, but the values of “trust” and “respect” were not mentioned. It seems that “trust” and “respect” of physicians in a society is the good will of these professionals which supports the efficiency of the treatment on one hand, and the conscious cooperation of the patient on the other. This matter is dependent on the physician’s effort in respecting the patient’s boundary and staying true to the physicians own technical and professional obligations. This article emphasizes the necessity this inseparable relationship, and the analysis of legal obligation in the light of such higher ethical values.
 

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.

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.
 

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. 

Good and healthy communication between physician and patient is cornerstone of a complete medical care that has long been considered in sociology. From the classical point of view, the physician-patient relationship as a unique relationship encompasses a wide range of cultural and social influences. Electronic health record not only has facilitated the treatment and diagnosis process, but also has promoted the health care system by organizing patient records; however, it alters the physician-patient relationship process culturally and it will create new ethical challenges. Based on current findings and analyses Opinions of health experts about the cultural and communication dimensions of this technology, the electronic health record, despite its effectiveness, easy and convenient diagnosis, awareness of other physicians' diagnosis, earlier and better treatment, has cultural obstacles such as security, reduction of emotional and face-to-face actions, and fear of social stigma. Having a suitable cultural context and information and awareness can affect development of health technology. The results of this study, which have identified the role of culture on physician-patient relationships in context of using electronic health record, shows that building trust in patients and changing cultural conditions through education and improving system security can increase the efficiency of this system in health care processes.

Medicine is a profession in which emotional and moral intelligence play an effective role in improving the quality of medical care for patients, mental health, and increasing job satisfaction. The aim of the present study was to investigate emotional and moral intelligence among different physicians. This study was conducted as a descriptive study. The statistical population consisted of all physicians in Mashhad in 2019. Among them, 213 physicians were selected by convenience sampling method and completed questionnaires. The data collection tools were the Bar-On Emotional Quotient Inventory (EQ-i) and the Moral Intelligent Questionnaire. Data were analyzed by Analysis of Variance (ANOVA) and independent t-test. The results showed that among physicians, female physicians, married, over 60 years old, and with a work experience of 30 years and more had more emotional intelligence. The results also showed that physicians over 60 years and a work experience of 30 years and more had higher moral intelligence. Therefore, it can be concluded that educating and selecting medical students and physicians based on measuring emotional and moral intelligence can give them better ability to solve problems and be more resilient when exposing to crises and difficult situations

The relationship between physicians and operating room staff includes interaction between them in caring for the patient to achieve a common therapeutic goal and condition improvement. Present cross-sectional descriptive-analytical study aimed to examine viewpoints of physicians and operating room staff about their relationship in Ahvaz at 2019. The research samples were operating room staff and physicians working in three educational hospitals affiliated to Ahwaz Jundishapur University of Medical Sciences. Consecutive samples were icluded in the study. The research tool was a two-part questionnaire including socio-demographic information and questions about the professional relationship between the doctors and the operating room staff. Results showed that viewpoints of physicians and operating room staff about respecting ethics in their communications are good.  In the group of physicians, 18.1% had a moderate viewpoint and 81.9% had a good viewpoint about communication with operating room staff. Among the operating room staff group, 4.8 percent had a bad viewpoint, 27.3 percent had a moderate viewpoint, and 67.9 percent had a good view point about their communication with physicians. Until reaching highest level of respecting professional ethics, any attempt to improve communication between physicians and operating room staff will result in positive outcomes for physicians and staff, and promote quality of their care for patients.