Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care

<div><p>Background</p><p>Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice.</p><p>Methods and findings</p><p>The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach.</p><p>A <i>clinical values space</i> was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of <i>clinician-as-consociate</i> emerged as an ideal for achieving medical excellence.</p><p>Conclusions</p><p>By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.</p></div

Respect.

<p>The keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews. The cut-off point, which divides the set of words into high-frequency and low-frequency groups, was identified. The graphs explaining the frequency of appearance were created with MS Excel 2007.</p

Value semantic networks.

<p>Keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews. The cut-off point, which divides the set of words into high-frequency and low-frequency groups, was identified. Radial graphs explaining the frequency of appearance were created with MS Excel 2007. The upper left-hand side (I) shows the most relevant values that are consistently mentioned and discussed by the participants prior to the CME intervention on clinical ethics. The lower right-hand side (II) shows the most relevant values that are consistently mentioned and discussed by the participants following the CME intervention on clinical ethics.</p

Hermeneutic methodological framework.

<p>In step 1, we used “naive reading” to build up semantical network to examine the axiology of clinical practice. In step 2, we used structural analysis of semi-structured interviews (SSIs) to examine. The core values of clinical practice. In step 3 we used interpretation analysis of SSIs to explore the axiology (Values space, clusters and Networks) in clinical practice prior to conducting the CME in clinical ethics. After research questions were examined, these results were integrated based on the mutual validation model, which regards the search for convergent findings as validity indicators.We explored potentially strong connections between EBM and VBM using qualitative results, while we inferred the extent of the benefits of novel Networks and clusters. After conducting the CME in clinical ethics intervention, we repeated the analyses (steps 2 and 3), and the full results were integrated.</p

Healthcare personnel-patient relationship value networks before CME training.

<p><b>A.</b> Keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews. <b>B. Healthcare personnel-patient relationship value networks after CME training</b>. Keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews.</p

Consociate clinician-patient relationship as cement for the EBM and VBM binomial.

<p>Quotations from interviews illustrating its key aspects.</p

Empathy value networks before CME training.

<p><b>A.</b> The keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews. <b>B. Empathy value networks after CME training.</b> The keywords were identified using the Atlas.ti 6.0 software. The words were sorted according to the frequency of their appearance in the interviews</p

“Values space, clusters, and networks”.

<p><u>Empathy</u> Empathy is a main value imbued in a larger axiological cluster, in which the central axis consists of <b>compassion,</b> universalism, <b>recognition of the person and their dignity</b>, benevolence, and a <b>positive clinician-patient relationship.</b> Originating from this main axiological pillar, we found <b>support, solidarity,</b> affective relationships, <b>patience, respect,</b> identification with others, therapeutic utility, improvement of the quality of life, <b>orientation, efficient problem solving, confidence,</b> and <b>responsibility.</b> <u>Respect</u> The axiological spinal cord of respect comprises <b>intrinsic dignity,</b> empathy, <b>autonomy</b>, <b>confidentiality</b> and understanding of multiculturalism. From these values, recognition of the patient’s will, <b>respect for the person</b>, <b>non-discrimination</b>, awareness of pain and suffering, professional secrecy, <b>fruitful clinician-patient relationship</b> and <b>communication are derived</b>. Of the above qualities, those marked in bold font are the values to which clinicians most frequently alluded before the CME intervention, although they did not necessarily name them as such. Those listed in regular font were either inexistent or barely perceptible before the course but began to appear in the second set of interviews.</p

Sample quotations from interviews illustrating clinician’s values.

<p>Sample quotations from interviews illustrating clinician’s values.</p