Work Culture in Medicine: Ethical, Legal and Social Challenges

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 17810

Special Issue Editors


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Guest Editor
Legal-Medicine Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
Interests: bioethics; medical law; legal medicine; medical malpractice; medical communication; violence against medical professionals; burnout in medical professionals
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Behavioral Sciences Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
Interests: behavioral sciences; medical psychology; chronic diseases; child psychology
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Legal-Medicine Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
Interests: forensic and legal medicine; medical malpractice; medical communication; bioethics; research ethics; forensic human identification; medical professional liability

Special Issue Information

Dear Colleagues,

The medical field is a specific work environment that is characterized by its own culture, in the center of which is the patient—the main beneficiary of medical services. In society, medical professionals are expected to ensure the health and well-being of the population. This means that have an important responsibility and makes society particularly sensitive to various activities in the medical field. For the medical system to properly function, high-quality medical care must be provided, which implies, on the one hand, a high degree of professionalism from those working in this field, and on the other hand, the establishment of a functional doctor–patient relationship based on trust. Medical activity in accordance with the standards of good clinical practice, in the context of a good relationship between professionals and patients, creates an environment in which patient safety is ensured, with this being the desideratum of medical systems worldwide. For this Special Issue, we expect the submission of research articles, reviews, systematic reviews and metanalyses that address the ethical, legal and social challenges of the work culture in the medical field, such as: relational issues between medical professionals and patients, as well as between members of medical teams; issues related to the impact of the profession on medical professionals such as burnout syndrome in medicine; the challenges posed by medical malpractice complaints and their consequences for professionals, patients, the healthcare system and society; the burden caused by acts of violence that occur in medical institutions, etc.

Prof. Dr. Beatrice Gabriela Ioan
Dr. Magdalena Iorga
Dr. Bianca Hanganu
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

 

Keywords

  • medicine
  • work culture
  • medical psychology
  • human behavior
  • (bio)ethics
  • medical law
  • social challenges
  • medical communication
  • medical malpractice
  • burnout
  • violence
  • patient–healthcare professional relationships

Published Papers (9 papers)

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Research

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14 pages, 322 KiB  
Article
Potential Conflicts of Interest Arising from Dualism of Loyalty Imposed on Employees of Medical Institutions—Findings and Tools for Ethics Management
by Rodica Gramma, Bianca Hanganu, Oleg Arnaut and Beatrice Gabriela Ioan
Medicina 2023, 59(9), 1598; https://doi.org/10.3390/medicina59091598 - 04 Sep 2023
Viewed by 1613
Abstract
Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient’s interests and [...] Read more.
Background and Objective: Doctors should have full loyalty to their patients, while patients should be able to trust that physicians will act only in their best interests. However, doctors may be faced with situations where they must choose between the patient’s interests and those of a third party. This article presents the results of a study that aimed to identify situations of duality in the decision-making process of medical workers, which can compromise their ethical behavior. Materials and Methods: A cross-sectional study was carried out on a sample of 1070 participants, employed in 120 healthcare facilities in the Republic of Moldova. An online questionnaire was completed anonymously. Descriptive statistics for discrete data were performed by estimating absolute and relative frequencies. To perform the multivariate analysis, the logistic regression was applied. Results: A large number (74.4%) of respondents admitted that they had faced situations of conflicts of interest. Every third respondent (35.3%) had experienced ethical dilemmas when access to expensive treatments should be ensured. Every fourth respondent experienced a conflict between the patient’s interests and those of the institution (26.1%) or the insurance company (23.3%). As age increases, the probability of reporting the dilemma decreases. Physicians reported such dilemmas almost 3 times more often than nurses. A low rate of staff sought support when faced with dilemmas. Half of the respondents (50.6%) preferred to discuss the problem only with a colleague, and 40.1% preferred to find solutions without anyone’s help. There were significant gaps within organizations in terms of the ethical dimension of the decision-making process. Conclusions: Managers should adopt clear institutional policies and tools to identify and prevent situations of dual loyalty. Ethical support should be offered to employees facing such situations. The need to promote an institutional climate based on trust and openness becomes evident. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
20 pages, 1897 KiB  
Article
The Relationship between Burnout and Wellbeing Using Social Support, Organizational Justice, and Lifelong Learning in Healthcare Specialists from Romania
by Roxana Mihaela Claponea and Magdalena Iorga
Medicina 2023, 59(7), 1352; https://doi.org/10.3390/medicina59071352 - 24 Jul 2023
Cited by 1 | Viewed by 1830
Abstract
Background and objectives: The goal of this study was to evaluate the levels of organizational justice, social support, wellbeing, and lifelong learning associated with the level of burnout experienced by medical and non-medical staff from public and private medical units. Materials and [...] Read more.
Background and objectives: The goal of this study was to evaluate the levels of organizational justice, social support, wellbeing, and lifelong learning associated with the level of burnout experienced by medical and non-medical staff from public and private medical units. Materials and Methods: A cross-sectional study was conducted on a sample of 497 healthcare professionals: 367 medical personnel (Mage = 43.75 ± 0.50), including 216 nurses, 97 physicians, and 54 respondents with other medical specialities such as biologists, psychologists, physical therapists, pharmacists, etc., and 130 non-medical staff respondents (Mage = 45.63 ± 0.80), including administrative personnel. The Maslach Burnout Inventory, the ECO System, the Multidimensional Scale of Perceived Social Support, the WHO Wellbeing Index, and the revised Jefferson Scale of Physician’s Lifelong Learning were used. Results: Burnout was measured in terms of emotional exhaustion, depersonalization, and personal accomplishment. Medical personnel registered higher values of personal accomplishment (38.66 ± 0.39 vs. 35.87 ± 0.69), while non-medical personnel registered higher values of depersonalization (6.59 ± 0.52 vs. 4.43 ± 0.26) and emotional exhaustion (27.33 ± 1.24 vs. 19.67 ± 0.71). In terms of organizational justice, higher scores were observed for medical staff, while non-medical staff recorded lower values (24.28 ± 0.24 vs. 22.14 ± 0.38). For wellbeing, higher scores were also registered for medical staff (11.95 ± 0.21 vs. 10.33 ± 0.37). Conclusions: For lifelong learning and social support, no statistically significant differences were found. In the case of the proposed parallel moderated mediation model, the moderated mediation effects of organizational justice, lifelong learning, and burnout on the relationship between social support and wellbeing were valid for every dimension of burnout (emotional exhaustion, depersonalization, and personal accomplishment), but lifelong learning was not found to be a viable mediating variable, even if high levels of social support correspond to high levels of lifelong learning and wellbeing. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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29 pages, 1354 KiB  
Article
Assessment of Labor Practices in Healthcare Using an Innovatory Framework for Sustainability
by Flaviu Moldovan, Liviu Moldovan and Tiberiu Bataga
Medicina 2023, 59(4), 796; https://doi.org/10.3390/medicina59040796 - 19 Apr 2023
Cited by 7 | Viewed by 1607
Abstract
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices [...] Read more.
Background and Objectives: The concept of sustainability in healthcare is poorly researched. There is a perceived need for new theoretical and empirical studies, as well as for new instruments to assess the implementation of new labor practices in the field. Such practices address unmet social needs and consolidate the sustainable development systems which promote health equity. The objective of the research is to design an innovative reference framework for sustainable development and health equity of healthcare facilities, and to provide a practical validation of this framework. Materials and Methods: The research methods consist of designing the elements of the new frame of reference, designing an indicator matrix, elaborating indicator content, and assessing the reference framework. For the assessment stage, we used sustainable medical practices reported in the scientific literature as well as a pilot reference framework that was implemented in healthcare practice. Results: The new reference framework suggested by the present study is composed of 57 indicators organized in five areas: environmental responsibility, economic performance, social responsibility, institutional capacity, and provision of sustainable healthcare services. These indicators were adapted and integrated into the seven basic topics of the social responsibility standard. The study presents the content of the indicators in the field of labor practices, as well as their evaluation grids. The innovative format of the evaluation grids aims to describe achievement degrees, both qualitatively and quantitatively. The theoretical model was validated in practice through its implementation at the Emergency Hospital in Targu Mures. Conclusions: The conclusions of the study reflect the usefulness of the new reference framework, which is compatible with the requirements in the healthcare field, but differs from other existing frameworks, considering its objective regarding the promotion of sustainable development. This objective facilitates the continuous quantification of the sustainability level, the promotion of sustainable development strategies, and sustainability-oriented approaches on the part of interested parties. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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12 pages, 333 KiB  
Article
Factors Affecting Health-Related Quality of Life among Healthcare Workers during COVID-19: A Cross-Sectional Study
by Gyehyun Jung and Jihyun Oh
Medicina 2023, 59(1), 38; https://doi.org/10.3390/medicina59010038 - 24 Dec 2022
Cited by 2 | Viewed by 2293
Abstract
Background and Objectives: Healthcare workers are threatened by psychological well-being and mental health problems in disasters related to new infectious diseases, such as COVID-19, and this can also have a negative impact on health-related quality of life. Health-related quality of life of healthcare [...] Read more.
Background and Objectives: Healthcare workers are threatened by psychological well-being and mental health problems in disasters related to new infectious diseases, such as COVID-19, and this can also have a negative impact on health-related quality of life. Health-related quality of life of healthcare workers should not be neglected because it is closely related to patient safety. This study aimed to identify the relationship between mental health problems, psychological safety, sleep quality, and health-related quality of life of healthcare workers and factors that influence health-related quality of life during the COVID-19 pandemic. Materials and Methods: Data were collected from 301 healthcare workers working in five general hospitals with more than 300 beds in two provinces from 5 July 2021 to 16 July 2021. Data were analyzed using SPSS WIN 27.0. The data were analyzed using t-test, one-way analysis of variance, and stepwise multiple regression. Results: Our results showed that there was a significant difference in regular exercise, religion, economic status, and sleep quality. The DASS-21 stress, economic status, and alcohol consumption were factors affecting the total health-related quality of life. In the subcategories, the physical component score was influenced by DASS-21 stress and economic status, while the mental component score was influenced by DASS-21 depression, economic status, alcohol consumption, and sleep quality. Conclusions: Health care workers need continuous and active monitoring of their health level and quality of life, as they are at a risk of increasing work burden and infection due to prolonged exposure to COVID-19 as well as mental health issues such as stress and depression. Additionally, at the individual level, active participation in various programs that can raise awareness of health-related quality of life along with physical health promotion activities should be encouraged. At the organizational level, it is necessary to prepare a compensation system, such as adjusting the workload of healthcare workers and ensuring break time; at the government level, disaster-related policies are needed to ensure a safe working environment for health care workers. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
17 pages, 1362 KiB  
Article
Empathy among Saudi Residents at a Tertiary Academic Center during the COVID-19 Pandemic and Its Association with Perceived Stress
by Haytham I. AlSaif, Mamdouh N. Alenezi, Mohammed Asiri, Khalid O. Alshaibani, Abdullah A. Alrasheed, Saad M. Alsaad and Mohammed A. Batais
Medicina 2022, 58(9), 1258; https://doi.org/10.3390/medicina58091258 - 11 Sep 2022
Cited by 2 | Viewed by 1792
Abstract
Background and Objectives: Empathy is an important attribute of a healthy doctor–patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels [...] Read more.
Background and Objectives: Empathy is an important attribute of a healthy doctor–patient relationship. Although multiple studies have assessed empathy in different countries, little is known about its levels among Saudi residents and its association with perceived stress. Objectives: To assess the levels of empathy and to identify if there is an association with stress in general and across the demographic and training characteristics of residents. Materials and Methods: A cross-sectional questionnaire-based study was carried out from December 2020 to March 2021 among residents training at a tertiary academic center in Riyadh, Saudi Arabia. Empathy and perceived stress were measured using the Jefferson Scale of Empathy (JSE) and the Perceived Stress Scale (PSS). Results: A total of 229 residents participated. The mean JSE score was 105.25 ± 15.35. The mean JSE scores were significantly higher among residents training in pediatrics (mean difference (MD) = 17.35, p < 0.001), family medicine (MD = 12.24, p = 0.007), and medical specialties (MD = 11.11, p = 0.012) when compared with surgical specialties and anesthesia. In addition, residents who worked 1–4 on-calls per month had a higher mean JSE score (MD = 11.23, p = 0.028) compared with those who worked 7 or more on-calls. Lastly, no correlation between empathy and perceived stress was detected in the whole sample (r = −0.007, p = 0.913); however, there was a correlation among residents training in medical specialties (r = −0.245, p = 0.025). Conclusion: Residents in our study had empathy levels comparable with Asian but lower than Western residents. We recommend qualitative studies that explore potential factors that might affect empathy among residents and studying the association between empathy and perceived stress among medical residents. Postgraduate curricula should incorporate interventions that foster a more empathetic doctor–patient relationship. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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Review

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12 pages, 330 KiB  
Review
The CARE (Curiosity, Attentiveness, Respect and Responsiveness, and Embodiment) Model: Operationalizing Cultural Humility in the Conduct of Clinical Research
by Sana Loue and Timothy Nicholas
Medicina 2023, 59(11), 2021; https://doi.org/10.3390/medicina59112021 - 17 Nov 2023
Viewed by 992
Abstract
Cultural competence training has been criticized for reinforcing existing stereotypes, ignoring intersectionality and inadvertently marginalizing some individuals and groups. In contrast, cultural humility offers the possibility of transformational learning, requiring individuals to pursue a lifelong course of self-examination. This approach makes authentic engagement [...] Read more.
Cultural competence training has been criticized for reinforcing existing stereotypes, ignoring intersectionality and inadvertently marginalizing some individuals and groups. In contrast, cultural humility offers the possibility of transformational learning, requiring individuals to pursue a lifelong course of self-examination. This approach makes authentic engagement with others possible. We review the premises underlying cultural competence and cultural humility, as well as proposed models for the integration of cultural humility into the clinical context. We propose a new model for the integration of cultural humility into clinical research: CARE, signifying Curiosity, Attentiveness, Respect and Responsiveness, and Embodiment. We conclude that the concept of cultural humility can be integrated into the conduct of clinical research. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
16 pages, 868 KiB  
Review
Midwives in Health Sciences as a Sociocultural Phenomenon: Legislation, Training and Health (XV–XVIII Centuries)
by Blanca Espina-Jerez, Laura Romera-Álvarez, Maylene Cotto-Andino, Mercedes de Dios Aguado, José Siles-Gonzalez and Sagrario Gómez-Cantarino
Medicina 2022, 58(9), 1309; https://doi.org/10.3390/medicina58091309 - 19 Sep 2022
Cited by 2 | Viewed by 1690
Abstract
Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography [...] Read more.
Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography of the 15th–18th centuries still has important bibliographic and interpretive gaps in the care provided by women. The main objective was to analyse the care provided by midwives in the legislative and socio-sanitary context of New Castile, in the inquisitorial Spain of the 15th–18th centuries. Materials and Methods: A historical review was conducted, following the Dialectical Structural Model of Care. Historical manuals, articles and databases were analysed. Results: The Catholic Monarchs established health profession regulations in 1477, including midwives. However, all legislations were annulled by Felipe II in 1576. These were not resumed until 1750. Midwives assumed a huge range of functions in their care commitment (teaching, care and religion) and were valued in opposing ways. However, many of them were persecuted and condemned by the Inquisition. They used to accompany therapeutic action with prayers and charms. Midwives were usually women in a social vulnerability situation, who did not comply with social stereotypes. Conclusions: Midwives, forerunners of current nursing and health sciences, overcame sociocultural difficulties, although they were condemned for it. Midwives achieved an accredited title, which was taken from them for two centuries. They acted as health agents in a society that demanded them while participating in a “witch hunt”. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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12 pages, 645 KiB  
Review
Physician-Patient Relationship in Current Cosmetic Surgery Demands More than Mere Respect for Patient Autonomy—Is It Time for the Anti-Paternalistic Model?
by Mihaela Hostiuc, Sorin Hostiuc, Mugurel Constantin Rusu and Oana-Maria Isailă
Medicina 2022, 58(9), 1278; https://doi.org/10.3390/medicina58091278 - 14 Sep 2022
Cited by 4 | Viewed by 2120
Abstract
The ethical framework of cosmetic surgery is distinct from the one associated with clinical medicine. This distinctiveness has led to significant difficulties in conceptualizing the physician-patient relationship (PPR), as most models have been developed specifically for the latter. The purpose of this article [...] Read more.
The ethical framework of cosmetic surgery is distinct from the one associated with clinical medicine. This distinctiveness has led to significant difficulties in conceptualizing the physician-patient relationship (PPR), as most models have been developed specifically for the latter. The purpose of this article is to show that the PPR in cosmetic surgery can be better described through a distinct approach that we name the anti-paternalistic model of the PPR, and we will briefly present the differences between it and autonomy-based models. We will analyze the principle of non-interference, the variable degree of autonomy of both the patient and the physician within this relationship, the handling of the relevant information, the principle of beneficence as satisfaction, the difficulties regarding the informed consent, the algorithm allowing for the refusal of the procedure, and children-related issues. Based on this analysis, we will show that an anti-paternalistic model of the PPR is preferable to an autonomy-based one, as it allows for better clarification of the underlying ethical issues involved in cosmetic surgery. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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Other

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8 pages, 268 KiB  
Essay
Soft Skills Are Hard Skills—A Historical Perspective
by Silvia Iorio, Marco Cilione, Mariano Martini, Marco Tofani and Valentina Gazzaniga
Medicina 2022, 58(8), 1044; https://doi.org/10.3390/medicina58081044 - 03 Aug 2022
Cited by 5 | Viewed by 2696
Abstract
The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today’s physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates [...] Read more.
The increasingly swift changes in the field of medicine require a reassessment of the skills necessary for the training of technically qualified doctors. Today’s physicians also need to be capable of managing the complex issue of personal relationships with patients. Recent pedagogical debates have focused on so-called “soft skills”, whose acquisition is presented in literature as a quite recent addition to medical studies. Moreover, the historical investigation of deontological texts dating from the mid-nineteenth century back to the Hippocratic Oath shows that medicine has always discussed the need to integrate technical expertise in medicine with specific personal and relationship-based skills. Debates have often circled around whether these “soft skills” could actually be taught or how they could be successfully transmitted to training physicians. The belief that defining medicine is more complex than defining other similar sciences and that the instruments to be used in the relationship with patients cannot be limited to those provided by technical aspects shows a new awareness. Today, this view is often stated as an innovative realization on the part of doctors with regard to the complexity of training and action in a delicate area in which they are entrusted with the management of the balance of the system that is the human body. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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