Iranian Journal of Medical Ethics and History of Medicine

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The appearance and the way a doctor is dressed has a very influential effect on the physician-patient relationship. Interns and trainees of medicine must follow the principles of professional behavior as they play a crucial role during their education. The aim of this research is to analyze the interns and trainee's point of view towards dress code.
In this study, after preparing a questionnaire and assessing its validity and reliability, it was sent to 337 interns and trainees of universities of medical sciences, at Shariati, Imam Khomaini and Sina hospitals, which are selected by portion method, after ward their viewpoints were analyzed from 5 dimensions.
One hundred and seventy seven students (52.5%) and seventy students (20.8%) got mean score and high score of physical features respectively.. Two hundred and sixteen students (64.1%) and fifty four students (16%) got mean and high score of dress code respectively. One hundred and eighty eight students (55.8%) and seventy five students (22.3%) got mean and high marks in make up respectively. Two hundred and twenty three students (66.2%)were completely in favor of observing personal hygiene while one hundred and fourteen students (33.8%) just agreed with this issue. Finally, in the total physical features and dress code, 210 students (62.3%) got the average mark and 58 students (17.2%) earned high mark. Interns and trainee's viewpoints about the physical features had a significant correlation with age, sex, and educational level (P<0.05).
The results of this study shows that teaching the importance of physical feature and professional dress code is the most important action to boost the level of compliance about appearance by interns and trainees. Compiling the professional dress code can help getting this aim come true.

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Nurses' ability to communicate with patients is essential for the effectiveness of the nursing process. This factor is more significant in the case of adolescent patients. Appropriate communication between adolescent patients and health care staff is crucial, since it contributes to the patients disclosing important personal information, and helps nurses communicate necessary information, viewpoints or skills through health promotion measures. The present study aimed to draw a comparison between nurses’ and hospitalized adolescents’ understanding of the significance of the nurse-patient relationship and the observance thereof. In this cross-sectional study, 175 nurses and 180 hospitalized adolescents (12-18 years of age) were selected through simple random sampling respectively, all of whom met the criteria necessary to enter the study. The data was collected from children’s hospitals affiliated with the Tehran University of Medical Sciences, and the data collection tools were self-report questionnaires. Data analysis was performed using the SPSS statistical software. Findings of this study showed that there was a significant statistical difference between the understanding of nurses and hospitalized adolescents regarding the importance of the nurse-patient relationship (P=0.019) and its observance (P0.001), and the nurses scored a better understanding than adolescent patients in both cases. This paper also investigated the priorities of each group regarding the significance and observance of the nurse-patient relationship. The results showed that nurses viewed explaining the necessary follow-up care after discharge as the most important part, while adolescent patients believed that proper verbal communication and being listened to patiently were of great significance. Both groups seemed to observe proper verbal and non-verbal communication according to the results of this paper. The findings of this research proved that nurses can be directed to achieve the less observed objectives that are viewed by adolescent patients as significant in order to eliminate the obstacles in proper nurse-patient relationship.

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Observing patients’ rights in health care services plays an important role in improving and adjusting the doctor-patient relationship and is therefore of great significance in health systems management. Considering the role it plays as an important philosophical part of modern ethics in ethical and social functions, empathy has received much attention in various areas of research such as psychology, behavioral studies, neurosciences and psychiatry. The present study will first offer an overview of the history of empathy and its positive effects on the interactions between doctors and patients, and then move on to propose strategies to promote empathy in doctor-patient relationships. Empathy plays a significant role in patient empowerment and satisfaction, and therefore studying its effects on teaching medical ethics as a factor that can positively influence the doctor-patient relationship can provide all, including organizations such as the Ministry of Health and psychology and counseling centers, with valuable guidelines to promote mental health, from prevention to treatment.

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Attempts to promote medical ethics principles on the national level should be consistent with the needs, expectations of the target audience, social orientations and determination of priorities. The present study was conducted through distribution of a questionnaire containing twenty medical ethics topics, and thus the priorities of instructors, researchers and policy makers regarding medical ethics were determined on a national level. Through determination of medical ethics priorities in the country, the study aimed to encourage a scientific approach to the issues and challenges faced throughout the nation based on the opinions of thinkers of this field, and to help resolve each of those issues according to national priorities. The findings revealed ten priorities in the field of medical ethics nationwide: patients’ rights, doctor-patient relationship, justice in the distribution of health care resources, autonomy and informed consent, the financial relationship between doctor and patient, hospital ethics committees, ethical considerations in public health, strengthening and capacity building in teaching medical ethics, ethical considerations in medical education, and medical research ethics.

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Medicine is known as a combination of science and art. Besides knowledge, a good physician should be equipped with the art of establishing communication with patients. The keystone of any efficient relationship like a therapeutic one is trust, and its deterioration makes the relationship deficient and based on mere need. Therefore, establishing an efficient relationship brings about positive results in treatment. In the last two decades, the trend in the physician-patient relationship has greatly changed, so that patient-centered care is now in focus. In this kind of relationship, physicians recognize patients as respectable human beings with their unique beliefs, attitudes, and concerns, etc. In this paper we intend to provide a brief introduction to the concept of physician-patient relationship and its chronological changes. Also, common models of physician-patient relationships (e.g. paternalistic, etc) are introduced, compared, and their most obvious strengths and weak points are analyzed. At the end, a succinct analysis on the dominant model(s) of physician-patient relationship in Iran&aposs medical settings has been provided, and the necessity of compiling a model based on Islamic values is proposed.

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Trust is a key element in the physician-patient relationship. Imam Jafar Sadiq (A.S.) stated that the proficient and trusted physician is in equal level of a just jurisprudent. Ancient ethical texts put much emphasis on physicians to be trusted. Nowadays, trust is a component of social health we believe that in the physician-patient relationship, trust has a significant impact on the practice, and increases the effectiveness of treatment and the satisfaction of patient and physician? also patient autonomy is preserved, health is positively reinforced, and patients will be more serious and less negligent with expenses, treatment, and follow up. This paper is a review/analytical article, and aims at classifying trust and examining its role in communication between physician and patient. If limited to practice, trust in the physician - patient relationship is divided into two types:

1- Unconditional trust, which means full confidence with no autonomy

2- Conditional trust, which entails maintaining autonomy.

 In the first type, where patient's autonomy is foregone, both patient and physician can be blamed. The patient is to blame due to an absence of self confidence and lack of participation in decision making and treatment, and the physician might in his place have the tendency to patronize. In this article we emphasize the importance of trust and warn against paternalism and conclude that if doctors truly comprehend the meaning of trust, they will try to avoid paternalism.

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The most important element in physician-patient relationship is trust which has a major effect on treatment and satisfaction of both patient and physician. To be able to realize the trust between patients and physicians, at first we should find an appropriate definition of trust so in this article we study the criteria of trust and it's realization to be adapted between patient and physician.We reviewed the literatures investigating the perspective of scientists of sociology and ethics. Afterwards the issue was discussed in focus groups, and the contents were analyzed to reach to a proposed model including several criteria.We believe that trust has two sides, the trust (patients) and the trustee (physicians) and for trust fulfillment both sides should be involved. So some criteria are related to the individual patients, such as patient's needs and desire to trust. Some are related to patients and are considered as respect to patients, awareness of physicians characters, such as his/her knowledge and experiences of physician.The other two criteria are related to physician's characteristics, such as his/her commitment and appearance, and physician-patient relationship, such as communication skills of physician.

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Trust is an important factor in the relationship between physician and patient. Trust between physician and patient is an important factor in improving patient and physician satisfaction, but it will not materialize unless we define trust and its criteria. Since trust fulfillment is dependent on its criteria, in this study we tried to define these criteria. First, we explicated the meaning and concept of trust through review articles, then we proceeded to content analysis, and lastly, the logical conclusion was obtained. In this article we have expressed scientific opinions and extracted 23 components from the cited opinions. We concluded that trust can be analyzed from three perspectives: the perspective of patients with 5 criteria, the physicians' view with 2 criteria and the perspective of an observer of the physician-patient relationship with 9 criteria.

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Breaking bad news is an unavoidable part of the medical profession, and doctors and patients stand at the two sides of this function. There are different views about how to break bad news in different cultures and societies. In this study we assessed the viewpoints of hospitalized patients on how to break bad news. This cross sectional study was performed in 2011 at the Jahrom University of Medical Sciences. Sample size of 110 patients was calculated and the method of sampling was simple random sampling. Target population was the hospitalized patients of Peymanyeh and Motahari hospitals in Jahrom. Entry criteria consisted of being admitted to the above hospitals, and exclusion criteria included severely ill patients and patients with mental disorders. A reliable self-administered questionnaire was designed and validated. The questionnaires were completed and returned by 110 patients. Data were analyzed using the SPSS16 software through descriptive analysis. One hundred and ten patients were included in this study. The factor analysis showed three elements: methods of breaking bad news, the people involved in the breaking bad news process, and timing and location. Of participants 78% wanted to be told the bad news while their relatives were present, 63.2% wanted to be told the bad news in a private and quiet room. Almost all respondents emphasized the need for religious advisors and psychological counselors (77.2% and 62.5% respectively). Most of participants (91.5%) wished to receive all the information about the etiology of their disease, and 74.8% of them wanted to be told whether their illness was cancer.This study showed that there are different views on how to break bad news in different cultures and societies. Social and cultural differences must be considered in breaking bad news. In our country, patients’ families could have a prominent supporting role in the delivery of bad news to patients.

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Refusal of medical treatment is among the most important rights of patients and a natural consequence of informed consent, although it can result in harm to patients or others and even the health care system. Treatment refusal may have various clinical manifestations whose recognition and proper understanding is essential to their management. In some cases the legal aspect is primarily dominant, such as when there is the possibility of harm to a third party. In other cases, for instance in absence of patient capacity, there are clear guidelines for decision-making. Major ethical challenges in the field of treatment refusal frequently pertain to capable patients, and this paper is mainly about the practical issues related to this group. The problems that these patients face are mostly due to improper physician-patient relationship or fleeting emotions. Caregivers should be prepared to deal with these issues and try their best to overcome obstacles and achieve patient satisfaction, with the exception of critical emergencies where treatment is carried out without consent. If all measures fail, patients’ refusal must be documented and other therapeutic interventions should be offered.

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Nowadays, electronic communications technology propounds new forms of the patient-physician relationship in the field of medicine. Effective communication between the patient and the physician can play a crucial role in the process of treatment. This new form of communication greatly influences promotion of the health system by improving access to inexpensive and fast services regardless of geographic boundaries. In times of crisis, telemedicine plays an important role in delivering health services to deprived areas in a just manner. Usage of communications technology is inevitable, and due to the virtual nature of this kind of medical communication, recognition of certain ethical considerations seems essential. Successful examples of telemedicine are abundant throughout the world and usage of this technology is a helping solution for inadequacies in the healthcare system. In Iran, because of the geographical extent of the country, this technology can provide access to medical services in some cases.In order to achieve the best outcome in telemedicine, it is essential to respect confidentiality, privacy, informed consent and commitment to professionalism in this field.

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