5.4 Blackbelt

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Case 2 – HIV and Blood Transfusion

An blood transfusion bag.

You are a medical student in an elective course in a developing country. The surgeon faces a complication during an operation and the patient needs blood. There are no blood banks and the surgeon encourages you to donate blood for a direct blood transfusion.

Question: How do you respond?

Case 3 – Patient Privacy and Comfort

A woman with her legs spread out for a vaginal inspection.

Your supervisor has just inserted a speculum into the vagina of a young woman when he is interrupted and asked to attend to another emergency patient. He departs abruptly, leaving the speculum in the woman’s vagina. You are asked to follow.

Question: How do you respond?

Guiding Principles for Ethical Engagement

  • Get to know patients and their communities
  • Share responsibility with local staff to create partnerships and reciprocal relationships
  • Professionalism–leadership and accountability–can create sustained change.
  • Always try to build on patient’s strengths–know the community and build on what works.

[Reference] Adapted from Australian Government, National Health and Medical Research Council 2006.

Ethics and the Starting Point of the Relationship Between Medical Staff and Patients

  • Humanitarian contexts and resource limited settings can intensify ethical dilemmas because of insecure environments, lack of optimum care, language barriers, and differing cultural values and perceptions of patients, communities and medical staff.
  • Time constraints, stressful conditions, and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care.
  • For example, ethical reflection has a central role in Médecins Sans Frontières (MSF) and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research.

Fundamental principles of professionalism

Question: What are the fundamental principles of professionalism?

  • Patient Welfare
  • Patient Autonomy
  • Social Justice

Read the video transcript

Medical professionalism is embedded in diverse cultures and national traditions but its members all share the role of healer. Global health professionals must contend with wide variety of political, legal and market forces that can impact how they deliver medical care. Despite these challenges, common themes of patient welfare and social justice emerge and this forms the basis of medical professionalism.

Duration: 22 seconds

What is Medical Professionalism?

A graph of all aspects of commitment. Here are the seven aspects, in no particular order: 1. Scientific knowledge, 2. Honesty with patients and confidentiality, 3. Professional responsibilities, 4. Improving access to quality care, 5. A just distribution of resources, 6. Maintaining appropriate relations with patients, 7. Professional competence and life-long learning.

Case 2 – HIV and Blood Transfusion (Revisited)

Read the video transcript

HIV can easily be transmitted by blood transfusions and ensuring testing of all blood products prior to transfusion is an important standard worldwide. Although unusual in Canada, in many resource-poor circumstances health care workers are commonly asked to give blood for emergency transfusions. If you are going to donate, it is critical to ensure the blood is tested for HIV, and Hepatitis B and C as well as undergoing typing and cross-matching, to ensure a good patient outcome. It’s also important to protect the donor.

Duration: 39 seconds

Case 3 – Patient Privacy and Comfort (Revisited)

Read the video transcript

Hello, my name is Patricia Topp and I’m a Nurse Practitioner with expertise in refugee health. Respecting patient dignity is an important component of professionalism. Ensuring privacy and comfort in resource limited settings however can be challenging. In this scenario there appears to be an opportunity to demonstrate professionalism. How? By removing the speculum and ensuring the patient is properly covered prior to leaving for the emergency. In this case it is probably best to simply support the patient and to be careful not to confront the attending physician unless you have committed to long term engagement at this hospital.

Duration: 40 seconds