Angeles University FoundationAngeles City, Pampanga

“The Calling of a Health Care Provider”

Submitted by:David, FlorielleDeang, Angela

Dela Cruz, DonnaGamboa, LoisGarcia, CalineGarcia, RachelLusung, Ashley

Manao, AngelicaPolicarpio, ArchieTarsenio, Maricris

Submitted to:Sir Ace William G. Pasion

The Calling of a Health Care Provider

The Health Care ProfessionI. Merton’s Values of a Profession (Knowing, Doing and Helping

Principles)

Merton (1982) summarized the essence of professionalism as a triad of values in the professions. The first value is knowing, that is, the development of a body of knowledge unique to the field and the training of the members in that unique body of knowledge. The second dominant professional value is doing, that is, the skilled application of the theoretical knowledge to the problems of life. Third, the acquired knowledge and skills are used in helping others.

II. Differences Between Profession and Occupation

The words occupation and profession are interchangeable. Profession and occupation are almost the same, with only minor differences between them.

The difference between occupation and profession can be stated with a simple example: Designing a building would be called a profession, whereas, constructing a building is an occupation.

A profession needs extensive training and specialized knowledge. On the other hand, an occupation does not need any extensive training. A person with an occupation need not have specialized knowledge of his trade.

A profession can be called an occupation when a person is paid for his particular skills, and his deep knowledge. Doctors, engineers, advocates, journalists, scientists, and many others, fall under the professional category. On the other hand, persons engaged in an occupation are not paid for their knowledge, but only for what they produce. Drivers, clerks and technicians fall under the category of occupation.

1. A profession needs extensive training and specialized knowledge. On the other hand, an occupation does not need any extensive training.

2. A profession can be called an occupation when a person is paid for his particular skills, and his deep knowledge. Persons engaged in an occupation are not paid for their knowledge, but only for what they produce.

3. Unlike a person engaged in an occupation, a professional has to undergo higher education.

4. A profession tends to be autonomous, whereas, for an occupation, no one has autonomous power; he or she is supervised by another person.

5. Unlike occupation, a profession demands that the responsibility lies with the individual.

6. A profession is guided through certain ethical codes, and regulated by certain statute.

III. Characteristics of Trust

Trust is a fundamentally important aspect of medical treatment relationships. 

Elements of trust

1. The subjective element

We 'feel' confident that we can trust another person. This is particularly the province of the 'Influential' type temperament that tends to make many judgements based on their feelings. It may also be the first response of individuals with a Kinaesthetic Perceptual Preference. ('Feeling' preference for 'receiving' rather than a hearing or seeing preference).

2. The objective element

We have examined all the facts, satisfied ourselves with all the data, yes this person is trustworthy - we are able to trust. This is more likely to be the attitude of the 'Compliant' or even the 'Dominant' type temperaments. They are driven less by their feelings and more by the facts.

3. The action element

Having made the decision to trust based on the other two elements, we then have to proceed and trust in some form. This could be with a task, or with a confidence, certainly in some format that would serve as a building block to a long term trust based relationship.

4. The reflective element

If this is a first time trust, it is good to reflect on the outcome. If the other person proved to be trustworthy and gained a satisfactory positive outcome, this will build your confidence. Over time, these positive experiences will serve to grow trust and build interpersonal relationships.

Trust is...

Accountability & Responsibility

If someone considers you to be trustworthy, then by accepting that trust you become accountable for a satisfactory outcome or result. You also accept the responsibility that goes along with it. We are responsible for delivering to expectation whilst honouring the trust that has been placed in us.

Some people choose not to trust as they wish to remain independent. Fuelled by their own self-sufficiency, they may even see it as weakness having to trust someone else for an outcome. At the other end of the spectrum are the 'dependents' who may look on a continuous basis to other people to take the lead and even design their destiny for them. Interdependency is the ideal status for the Trustworthy adviser and client. This not only fuels mutual trust but also mutual respect, mutual concern and mutual comfort.

Vulnerability and Risk

By putting his/her trust in you, clients can make themselves vulnerable to you by relinquishing partial or perhaps even total control for an outcome. This is not done either easily or lightly.

Strong emotions are always involved when we make ourselves vulnerable, only to find that trust is broken. We feel let down and usually angry with the person who betrayed our trust. If we trust someone, we are taking the risk that for better or worse they will affect the outcome. This can be particularly difficult for people with an obsessive - compulsive personality or perfectionism tendencies. They are usually very conscientious, able to do a good job themselves and find it difficult to trust others to do as good a job as they themselves would manage.

IV. Health Care Provider and Patient Relationship

By the phrase “healthcare provider” we mean primary care physicians, specialist physicians, nurse practitioners, physician assistants, medical technologists, and others who act to diagnose and treat patient illnesses and disorders in healthcare settings.  In the course of healthcare encounters patients may interact with many other clinicians such as nurses and technicians, but it is the healthcare provider who most determines the course of the therapeutic relationship.

Certain aspects of the relationship between providers and patients are generally accepted and relatively uncontroversial.  The relationship is seen

as fiduciary, meaning that it is based on trust.  The patient trusts the provider with his or her healthcare and the provider is expected to fulfill certain duties toward the patient.  Obligations toward patients include:

1. Technical competence in the provider’s area of expertise2. Acting so as avoid harming the patient (non-maleficence)3. Acting for the patient’s benefit (beneficence)4. Keeping patient information confidential (under normal circumstances)

The provider is also considered to be a professional.  A profession has standards and expectations about such matters as established methods of specialized training, possession of proper certification, mastery of requisite skills, possession of authoritative knowledge, expectations of appropriate behavior and judgment, high quality of performance, devotion to the area or field of expertise, and codes of ethical conduct.

Besides what is mentioned above, physicians should, among other things, avoid exploiting patients, avoid engaging in sexual relations with patients, and respect the rights of patients to make their own decisions about treatment and procedures.

V. Duties and Rights of a Patient

As a patient, you have the right to: Receive medical care. You have the right to receive medical care no

matter what your race, sex, beliefs, country of birth, religion, sexual orientation, gender identity or expression, disability or source of payment.

Be treated with dignity and respect. You have the right to be free of any abuse, neglect, shame, and/or feeling like you are being taken advantage of or revenge from those providing care to you.

Have your values and beliefs respected. Please let us know if you have cultural or religious practices that need to be part of your care. You have the right to get help for special needs. This could include special meals because of religious or cultural practices.

Have accessibility services. This may include reasonable access to an interpreter to communicate with your healthcare team in the language you prefer, have reasonable access to translated materials, large print, TTY phones, amplifier and other devices that can aide in improving communication.

Use clothing and other personal items. You may bring in your own clothing and other personal items as long as they are safe and not offensive to others. You will have use of a telephone and may receive mail. Phone contact, mail and visitors may be limited at times because of your medical condition. If there are questions about these, please talk to the nurse, social worker or your doctor.

Have visitors of your choice. You can ask staff to help limit your visitors to certain people or times. Hospital policy says visitors may be limited if required for your health or safety, or the safety of other patients or staff. Please ask for a copy of the policy if you want more information.

Receive age-appropriate care and education. Children who are patients have the right to care and education that meets their age and developmental needs.

Expect personal privacy. You can expect privacy in care discussions, exams and treatments.

Keep your medical records private. You have the right to have your medical records and plans for your care kept private. Your medical record will not be given to anyone without your consent, except when required by law or by your insurance plan.

Keep your identity private. You can expect that any images or recordings with information that could identify you will be kept private.

Know who is caring for you. You have the right to know who is caring for you and what their position is at the hospital. Ask members of your health care team to tell you their name, and what care they will give to you. All hospital staff should be wearing ID badges.

Receive clear communication. You have the right to receive information about your care given to you in a way that you can understand. If you are not sure what you have been told or have been given in writing, ask a member of your health care team to go over the information again with you. We need your approval to share any information about your health, your care or your treatment with family and friends.

A safe and clean environment. You have the right to a safe, clean and secure environment while you are in the hospital.

Report concerns regarding care and safety. You have the right to report concerns or complaints about your care and safety and receive help to resolve your concerns.

Request hospital policies. You have the right to know the rules and policies of the hospital that involve your care during your hospital stay. These include the policies for visitors, safety and no tobacco use.

Participate in decisions about your care. You have the right to make decisions about your care, treatment and services, including refusing treatment.

Give or refuse consent for treatment. You have the right to know the risks, benefits and other options for treatment before you give consent for treatment, except in an emergency situation.

Have your pain evaluated and managed. Your healthcare team will ask you about your pain and will help you with pain management.

Get a second opinion. If you are not sure about your care or treatment plan, you may ask for the advice of another doctor or care team member.

Complete advance directives. You have the right to complete advance directives that can include a living will, do not resuscitate (DNR) order and

durable power of attorney for health care. The durable power of attorney for health care allows you to identify another person to make decisions about your care if you are not able to for any reason. You can ask for help to complete an advance directive. 

Receive written discharge instructions. You have the right to receive written discharge instructions from your doctor about your follow-up care before leaving the hospital.

Request a meeting with the Hospital Ethics Committee. You or your family can ask for this help to discuss issues about your care.

See your medical record. Your doctor can review your record with you in the hospital, if you ask. After you leave the hospital, you can call the office of Medical Information Management to get your records. You can also ask for changes or corrections to your record based on laws and rules.

Receive information about the cost for your treatment and payment options. If you have questions about your hospital bill, please ask to talk to a financial assistance counselor.

Choose whether or not you want to be part of clinical trials or educational programs. Research to improve health is part of the mission of Ohio State’s Medical Center. We may use patient information in research but we will not identify patients unless we have their permission.

Receive information about transfers. You have the right to receive information about a transfer to another doctor, unit or facility before it happens.

There are a number of things that you can do to help health care workers provide better care. You should:

To call your personal doctor first before going to another doctor or clinic or to the emergency room if it is not a real emergency;

To give as many facts as you can to help your doctor or other health care provider take care of you;

To call your doctor or clinic and let them know if you cannot come to an appointment;

To follow the instructions you get from your personal doctor or clinic; To ask questions about anything you do not understand; and To follow the rules set up by your personal doctor for his or her

office or clinic. This includes showing respect and courtesy to the doctor, his or her employees, and other patients and their families.

VI. Factors Needed in Ethical Decisions

Ethics is always related to knowing what is right and differentiating it from what is wrong. When people do ethical decision making, it is always necessary to choose what is right over the other choices.

But there are certainly a lot of factors that may affect the ethical decision that a person is going to make. One of the factors that will really affect how a person makes an ethical decision is his or her own set of morals and values. Even though ethics and morals are different, people associate morals into these decisions because these are what they think is correct and just.

Another factor that could affect the decision of an individual is the person involved in the problem. It is generally much harder to make a decision when you are close with the people in the situation as to making a choice between people that you do not know.

The set of principles of a person might be different from the views of another. This is primarily due to the influence obtained by the person while growing up. One of the great sources of principles is family. The series of standards that a person has may also be dictated by religion and culture.

VII. Psychoanalytical Model

People present themselves for medical care because they have a "problem.' The problem is usually, a symptom, a manifestation that gives them grounds for believing something is amiss. Pain, fatigue, and functional incapacity are examples. Frequently, the symptoms are accompanied by a sign or signs, observed by the physician, such as jaundice or pallor or a particular odor. The symptom reported and the signs observed all are defined as departures from a norm of physical function and, therefore, are deserving of further investigation. Symptoms, in this model, are conceptualized to be the result of some pathological process ongoing in the patient, (e.g., infection), on the basis of which conceptualization further examination is conducted to determine the nature of the pathology.

As pathology is conceived to be causal to symptomatology, so is etiology causal to pathology. Thus, for example, infection is caused by a particular etiological agent, say, streptococcus B, which is deemed to be the fundamental basis for the manifestations that have appeared in the diagnostic study of the individual and that define that individual as a patient.

This model of a hierarchical relationship of symptomatology pathology, and etiology has important characteristics. First, it constitutes a theoretical ideal of the diagnostic process. If one can know the three elements of the model, one can understand fully the multiple departures from the norm of the physical processes involved in any disease entity. Further, the model provides an ideal that parallels the ideal model of treatment for disease. One can treat symptoms palliatively, for example, using analgesics for pain. Or one can treat pathology in a general way," for example, using broad-

spectrum antibiotics for an infection. Finally, the knowledge of the etiology enables the selection of a specific treatment choice as well as the development of preventative methods for the protection of individuals and, ultimately, the elimination of the etiological agent from nature.

In the treatment model that interfaces the diagnostic model I have just reviewed, the patient is understood to be without responsibility for any of the three aspects of the disease. To be sure, a patient may be responsible for creating conditions of living that make a disease process possible, but once it has begun, the patient's responsibility for it and the power to alter it diminish or disappear. At that point, the health care professional assumes responsibility for prescribing the treatment and implementing its application. The patient, in this model, is limited to complying or not complying with what has been prescribed.

VIII. Characteristics of a Good Health Care Provider

1. Professionalism. Health care providers may be expected to attend board meetings that may include senior doctors or nurses. This requires the provider to be professional in collaborating with others, working as part of a team. The provider should be able to create a professional environment to help assure the patient that the health care facility's services are trustworthy and reliable.

2. Emotional stability. Health care providers should be able to handle stressful situations, such as caring for terminally ill patients. Other factors may also contribute to stress, such as dealing with the death of a patient. The provider must be emotionally stable and not allow these types of incidents affect job performance.

3. Sharp appearance. Health care providers should be neat in appearance. Most employers expect providers to be well groomed. In addition, many employers don't allow heavy jewelry and accessories to be worn with the health provider's uniform.

4. Good communicator. Good communication skills are essential to a health provider. Providers should have the ability to communicate with patients and families about care plans and hospital policies. The provider should also be a good listener when addressing a patient's concerns or needs. Providers may be required to communicate with other employees to help provide patient care.

5. Caring. Health care providers usually deal with patients who are severely ill. They must provide a caring and warm environment to help

ease the patient's discomfort. The provider should be compassionate and able to speak kind words to the patient.

6. Flexible. Health care providers, specifically those who work in hospitals, may be required to work long hours that include weekends and holidays. They may be required to be on-call in the event of an emergency. Providers must be flexible and willing to arrange their work schedules to meet their employer's needs.

7. Detail-oriented. Health care providers should follow directions carefully to help avoid errors, specifically when administering a patient's medication.

IX. Commitment of a Health Care Provider

1. Commitment to professional competence. Health care workers must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality health care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.

2. Commitment to honesty with patients. Health care workers must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust.

3. Commitment to patient confidentiality. Earning the trust and confidence of patients requires that appropriate confidentiality safeguards be applied to disclosure of patient information. This commitment extends to discussions with persons acting on a patient’s behalf when obtaining the patient’s own consent is not feasible.

4. Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients, certain relationships between health care workers and patients must be avoided.

5. Commitment to improving quality of care. Health care workers must be dedicated to continuous improvement in quality health care. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical

error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care.

6. Commitment to scientific knowledge. Much of medicine’s contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Health care workers have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use.

7. Commitment to professional responsibilities. As members of a profession, health care workers are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation, including remediation and discipline of members who have failed to meet professional standards.

X. Health Professional Relationships with Other Health Professionals

1. Mutual Responsibility

Mutual responsibility for (or joint ownership of) a partnership denotes a highly developed and sophisticated level of commitment, often referred to as “collaboration.” Different levels of commitment can be described in terms of a hierarchy, with collaboration being the highest (deepest) level.

2. Mutual Support

Mutual support is the essence of teamwork. It creates a “safety net” for both patient and caregiver by:

o Reducing work overload situations o Increasing effectiveness of caregiverso Decreasing the risk of error

3. Mutual Respect

Recognizing workers' talents and contributions regardless of diverse cultural or physical characteristics is just one component of mutual respect. In the workplace, there is one common goal: profitability. Employee diversity is a non-factor in assessing employee capabilities where the quality of work is an issue. Mutual respect in the workplace is based, in large part, on respect for colleagues' abilities and skills -- how well their expertise matches their job assignments. Mutual respect acknowledges talent, not race, color, gender or culture.

Respect for coworkers and their respective roles in the workplace encourages a collegial work atmosphere. It also fosters collaboration,

synergy and cooperation, which are essential ingredients for creating a workforce that values productivity, performance and the quality of its products or services.

Virtues of Health Care Providers

I. Fidelity

The principle of fidelity broadly requires that we act in ways that are loyal. This includes keeping our promises, doing what is expected of us, performing our duties and being trustworthy. Role fidelity entails the specific loyalties associated with a particular professional designation, and Purtillo (2005) lists five expectations associated with what patients might reasonably expect in terms of fidelity in the health care context:

1. That you treat them with basic respect.2. That you, the caregiver or other health care professional, are

competent and capable of performing the duties required of your professional role.

3. That you adhere to a professional code of ethics.4. That you follow the policies and procedures of your organization and

applicable laws.5. That you will honor agreements made with the patient.

II. Honesty

Medicine is a powerful instrument of both good and harm, depending upon how medical knowledge and skill are used. Knowing when one does not know and having the humility and ability to admit it and to obtain assistance are virtues critical to avoiding harm and demand intellectual honesty.

III. Integrity

Integrity is the quality of being honest and having strong moral principles; moral uprightness. It is generally a personal choice to uphold oneself to consistently moral and ethical standards.

In ethics, integrity is regarded by many people as the honesty and truthfulness or accuracy of one's actions. Integrity can stand in opposition to hypocrisy, in that judging with the standards of integrity involves regarding internal consistency as a virtue, and suggests that parties holding within themselves apparently conflicting values should account for the discrepancy or alter their beliefs.

IV. Humility

Humility is claimed to be a moral virtue in certain ethical systems. Humility is the quality or condition of being meek and submissive. Since virtues are guides to actions, humility as a virtue asks that you act pathetic, lowly, and ignoble. True humility requires you to believe it.

Humility is the opposite of pride. As opposed to the crown of virtues, humility is the poison of virtues. Every act of virtue is cause for scorn, because you are attempting to be good. Instead of accepting yourself as a worm, you are trying to be human. This is a great sin in many ethical systems. If you are happy about who you are, you will want to live for yourself. This is clearly unacceptable in ethical systems, such as altruism, where you are to sacrifice yourself for others. Pride gets in the way of sacrifice. Only humility serves that end.

V. Respect

Respect is a quality we are all capable of giving to others and we should also expect to get it back. Respect is no matter what your job is always have respect for yourself and do your job well. Respect your co-workers no matter how small their job maybe. Respect is also being honest, kind, compassion, and loyal to yourself and others. Respect is important because it helps you to choose good friends and strength your character. Respect is something earned. It also taking people's feelings, needs, and thoughts into consideration. Respect cannot be demanded or forced even though some people thinks so.

VI. Compassion

Compassion is feeling for the loss/suffering of another with an attempt beyond obligation to help or avoid that loss/suffering. For any situation or clinical decision, a physician must assume the predicament of the patient in order to feel something of the patient's plight if his scientific judgments are to be morally defensible and suited to the life of that patient.

VII. Prudence

It is defined as the intellectual virtue which rightly directs particular human acts, through rectitude of the appetite, toward a good end. Emotional well-being, we will argue, comes about through a certain structuring of the entire network of human emotions, one that results from a proper disposing of the emotions by the virtues. If we are correct, then prudence is the mother of emotional health.

Prudence, however, is not merely an intellectual virtue; it is also a moral virtue. A moral virtue is a habit that makes its possessor good. One may be brilliant and learned without being morally good, but it is not possible to be prudent and not morally good. The prudent man is one who does the good, as opposed to one who merely knows the good.

VIII. Courage

We too often think of courage in modern life requiring unique heroism or call to duty on a grand scale, such as in situations of rescue and war. Of course, in war humans sometimes fight because they are embarrassed not to. For courage to be authentic, one must encounter fear and prove superior to the fear through right action.

Fear of what? Most directly, physical courage exists in the face of bodily harm or death. In other words, physical courage is demonstrated by acting regardless of fear for one's life or livelihood. We need a different kind of courage than physical courage on a daily basis. Leadership character requires moral courage: to become a better leader; to stand up for what is right when we stand alone; to do what is right despite disapproval or negative peer pressure; or to take risks in our quest to achieve what is important. These take Courage -- without it we go nowhere, accomplish little, lack meaning and regret much. Courage is the primer for any other virtue.

IX. Truth

Patients normally assume their healthcare provider is telling them the truth about a diagnosis, the results of a test, or in recommending treatment options. Historically, providers have not been as honest and revealing as patients probably assumed. Physicians sometimes felt patients couldn’t handle the truth. Decades ago, if a patient were diagnosed with terminal cancer the physician sometimes felt it was best if the patient wasn’t told. Better to let the patient enjoy their last few months happy rather than sad and depressed.

X. Love

Ethical thinkers have to the present day laughed at the ethic of love. They have considered love only in its social aspects, and not as personal love with inclusive teleology. To them love has meant only altruism, which to their way of thinking is something meaningless to the modern man, charged as he is with the responsibility of self-realization.

Love is the social cohesive force: it has the power to bind society together from within. That is, love is not humanly originated, but may be

regarded as the dynamic and explosive force experienced within the re-created spirit. Hence, in the ethics of love we think not merely of social morality, but we discover the inner power of God, perennially creative; and we discern the form of Godlike perfection, transcending that of so-called perfectionism, entering into our inner nature.

XI. Faith

XII. Hard Work

XIII. Social Justice

Justice refers to an equitable balance of benefits and burdens with particular attention to situations involving the allocation of resources. Munson (2004) offers four specific principles of distributive justice that can be considered in situations involving the distribution of material goods and resources, especially those that are scarce. The principle of equality requires that all benefits and burdens be distributed equally. The advantage to this conception of justice is that everyone is entitled to an equal share of resources; however the principle becomes problematic when not everyone is perceived as equally deserving of an equal share.

Vices

I. Authority and PowerII. Pride

Pride is excessive belief in one's own abilities that interferes with the individual's recognition of the grace of God. It has been called the sin from which all others arise. Pride is also known as Vanity.

III. Greed

Greed is an excessive desire to possess wealth or goods with the intention to keep it for one's self.

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virtue-of-prudence.html Purtillo, R. (2005). Ethical dimensions in the health professions (4th ed).

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