Iranian Journal of Medical Ethics and History of Medicine

Breaking bad news to the patients does not back to a long history and is a controversial issue between patients and physicians. Many physicians are reluctant to breaking bad news to patients and this is not desirable for most patients. For example, in Northern European countries and United States, most physicians usually break bad news to the patients, while in Southern and Eastern European countries or many Asian countries they would not do so. In Iran, physicians prefer to break bad news to patient's family rather than the patient. Cultural differences also influence people's viewpoints about breaking bad news. In Western countries, most people agree with breaking bad news to patients while it is not common in the other populations. Nowadays, the dominant view in the most countries is that it is the duty of the physicians to break bad news to patients. Some advantages of breaking bad news to patients including strengthening the trust between physician and patient, preventing non - maleficience, increasing patients satisfaction and reducing legal action against the doctors. There are some exceptions to breaking bad news the most important is serious psychological damage to the patient. Quality and quantity of information that should be released depends on situation of each patient. Breaking bad news needs specific communication skills and physicians must be trained for this purpose.

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.

Moral intelligence is the ability to utilize principal criteria that can lead to effectiveness of individual reactions. The aim of this study was to determine the relationship between moral intelligence and communication skills among bachelor’s students in nursing at Tehran University of Medical Sciences, Iran, in 2016-2017. 

This was a descriptive-correlational study. The study population consisted of all nursing students studying at the School of Nursing and Midwifery of Tehran University of Medical Sciences. Among the study population, 204 subjects were selected through convenience sampling method and based on the inclusion criteria (direct acceptance in the field of nursing, absence of any illness, and willingness to participate). The data collection tools consisted of a demographic characteristic questionnaire, the Moral Intelligence Scale (Lennick & Kiel), and the Communication Skills Inventory (Jerabek). The validity and reliability of both instruments had been approved in similar studies in the country using Cronbach's alpha coefficient (α = 0.88 and α = 0.71, respectively). The reliability of the two questionnaires was calculated in the current research using Cronbach's alpha (α = 0.85 and α = 0.81, respectively). Data were analyzed using descriptive (average and standard deviation) and inferential statistics (t-test, Pearson correlation coefficient, and ANOVA test) in SPSS software. The mean moral intelligence score was 71.98±7.12 and ranged from 20 to 100 and mean communication skills score was 114.9±9.67 and ranged from 34 to 170. Pearson correlation coefficient revealed a significant and positive relation between moral intelligence and communication skills of nursing students (r=0.54, P ≤ 0.001). Thus, the communication skills of students can be improved by strengthening their moral intelligence. Therefore, it is suggested that the grounds for the strengthening of moral intelligence among nursing students be provided.