I follow the principles of ethics and deontology. Fundamentals of medical deontology

It is impossible to live pleasantly without living reasonably, morally and justly.
Eppcourt

Each specialist working with healthy and sick people must acquire the knowledge and skills to communicate with them, the skills of a teacher and educator. This provision is especially important when it comes to the communication of a doctor, educator (teacher) with ballroom or disabled people. In fact, for these purposes, it is quite acceptable to use the basic principles of medical deontology and ethics.
The goals of medicine organically include moral assessments, not only because they imply ethical norms of the relationship between the doctor and the patient, but also because the observance of deoptological norms by physicians in itself gives a therapeutic effect.

Virtue and wisdom without knowledge of the rules of conduct are like foreign languages, because in this case they are usually not understood F. Bacon
Deontology (Greek deon, deontos - due, proper + logos - teaching) - a set of ethical standards for the performance of their professional duties by health workers (BME, vol. 7, p. 109, 1977).
The term "deontology" was introduced into the everyday life of ethics at the beginning of the 19th century. English philosopher Bentham. Some authors equate the concepts of medical ethics and deontology. In fact, these concepts are closely related, but not identical, since deontology is the doctrine of the rules of behavior of a doctor, arising from the principles of medical ethics and based on them.
The subject of medical deontology is mainly the development of ethical norms and rules of conduct for a medical worker in his communication with patients. However, despite the fact that the concepts of "medical deontology" and "medical ethics" are not identical, they should be considered in a dialectical relationship, "... under medical deontology, we ... must understand the doctrine of the principles of behavior of medical personnel" (N.I. . Pirogov).
The norms and principles of medical deontology and ethics can correctly guide a medical worker in his professional activity only if they are not arbitrary, but scientifically substantiated. Only then will they be theoretically meaningful and will find wide recognition. The great physician of the distant past Hippocrates wrote: “The doctor is a philosopher, he is equal to God. Indeed, there are few differences between wisdom and medicine, and everything that is available for wisdom, all this is also in medicine, namely: contempt for money, conscientiousness, modesty, simplicity in dress, respect, determination, neatness, abundance of thoughts, knowledge of everything that is useful and necessary for life, aversion to vice, denial of superstitious fear "of the Gods", divine superiority.
Compliance with moral standards is one of the necessary aspects in the activities of any specialist working with people. The most important feature of their moral duty is that all their actions and actions are taken for granted. A.P. Chekhov said that "the profession of a doctor is a feat, it requires dedication, purity of soul and purity of thoughts."
Medical deontology - a spider about due, develops the principles of behavior of medical personnel aimed at achieving the maximum therapeutic and health-improving effect through strict adherence by physicians to ethical norms and rules of conduct. The principles of the doctor's behavior follow from the essence of his humane activity. Therefore, bureaucracy, a formal soulless attitude towards a sick person (disabled person) is unacceptable.
The basic principles governing the moral character of a doctor have been formed over the centuries. Already in the Indian code of laws Manu "Veda" the rules of behavior of a doctor are listed in detail, understood as ethical norms.
In the ancient world, medical views, as a rule, were directly related to philosophical, ethical and social doctrines. An outstanding role in defining the main problems of medicine as a science and as a moral activity belongs to the founder of scientific medicine Hippocrates. Directly related to the problems of medical deontology are the sections of Hippocrates' collection "Oath", "Law", "On the Doctor", "On Favorable Behavior". Here Hippocrates formulated a number of deontological norms. Hippocrates formulated the obligations of the doctor in relation to the patient in the famous “Oath”: “I will spend my life and my art purely and blamelessly ... In whatever house I enter, I will go there for the benefit of the patient, being far from everything intentional, unfair and pernicious ... Whatever I see or hear about human life from what should never be divulged, I will keep silent about it, considering such things a secret ... ®.
In medieval medicine, doctors were also not alien to the norms of medical deontology. For example, they were set out in the "Salerno Code of Health" and in the "Canon of the Medical Spider" and "Ethics" by Ibn Sina.
In the Renaissance, the humane precepts of the great ancient physicians were recognized. The well-known physician and chemist T. Paracelsus wrote: “The strength of the doctor is in his heart, his work must be guided by God and illuminated by natural light and experience; the greatest foundation of medicine is love.”
Russian clinicians (M.Ya. Mudrov, S.P. Botkin, A.A. Ostroumov, etc.) strictly adhered to the principles of deontology in their professional activities. Prominent public figures, humanists A.I. Herzen, D.I. Pisarev, N.G. Chernyshevsky and others.
The merit of introducing the term “medical deontology” into the practice of Soviet healthcare and revealing its content belongs to N.N. Petrov, who defined it as "... the doctrine of the principles of a doctor's behavior not to achieve individual well-being and honors, but to maximize the amount of social utility and eliminate the harmful consequences of inadequate medical work."
Only a doctor who has chosen his profession according to his vocation can build his activity in accordance with the requirements of medical deontology. To love your profession means to love a person, to strive to help him, to rejoice in his recovery.
Responsibility for the patient and his health is the main feature of the doctor's moral duty. At the same time, the doctor's task is to exert a psychological influence on relatives when the intervention of the latter can adversely affect the patient's condition.
In creating an optimal environment in medical institutions, high service and professional discipline, nurses help the doctor. High culture and neatness, cordiality and caring, tact and attentiveness, self-control and disinterestedness, humanity are the main qualities necessary for a nurse. She must be proficient in the art of the word in communicating with patients and their relatives, observe a sense of proportion and tact, make every effort to create an atmosphere of trust between the patient and the doctor.
Relationships between doctors, nurses and paramedics must be impeccable and based on absolute mutual trust. In medical institutions such an environment should be created that would spare the psyche of patients as much as possible and give rise to an atmosphere of trust in the doctor.

11.1. Fundamentals and principles of medical deontology

Ethics is an unlimited responsibility for everything that lives.
A. Schweitzer

Ethics (from the Greek cthika - custom, rights, character) is a philosophical science that studies issues of morality and ethics.
Ethics. In a narrower sense, medical ethics is understood as a set of moral norms for the professional activities of medical workers. In the latter sense, medical ethics is closely related to medical deontology.
Ethics studies the relationship of people, their thoughts, feelings and deeds in the light of the categories of goodness, justice, duty, honor, happiness, dignity. The ethics of a doctor is a truly human morality and therefore only a good person can be a doctor.
The moral requirements for people involved in healing were formulated back in the slave-owning society, when there was a division of labor and healing became a profession. Since ancient times, medical activity has been highly revered, because at the heart of it was the desire to save a person from suffering, to help him with ailments and injuries.
The most ancient source in which the requirements for a doctor and his rights are formulated is considered to be related to the 18th century. BC. "Laws of Hammurabi", adopted in Babylon. An invaluable role in the history of medicine, including the creation of ethical standards, belongs to Hippocrates.
He owns the axioms: “Where there is love for people, there is love for one’s art”, “Do no harm”, “Physician-philosopher is like God”; he is the creator of the surviving "Oath" that bears his name. Hippocrates for the first time paid attention to the relationship of the doctor with the relatives of the patient, the relationship of doctors. The ethical principles formulated by Hippocrates were further developed in the works of ancient doctors A. Celsus, K. Galen and others.
Physicians of the East (Ibn Sipa, Abu Farzdzha and others) had a great influence on the development of medical ethics. It is noteworthy that even in ancient times the problem of the relationship of a doctor to a patient was considered in terms of their cooperation and mutual understanding.
In Russia, advanced Russian scientists have done a lot to promote the humane orientation of medical activity: S.G. Zybelin, D.S. Samoilovich, M.Ya. Mudrov, I.E. Dyadkovsky, S.P. Botkin, zemstvo doctors. Of particular note are the “Sermon on piety and moral qualities of the Hippocratic doctor”, “Sermon on the way to teach and learn practical medicine” by M.Ya. Mudrova and works by N.I. Pirogov, which are an "alloy" of love for their work, high professionalism and care for a sick person. The "holy doctor" F.P. Haaz, whose motto was "Hurry to do good!".
The humanistic orientation of the activities of Russian doctors is described in many ways in the works of writers-physicians A.TT. Chekhov, V.V. Veresaeva and others.
Morality is one of the oldest forms of social regulation of human behavior and human relationships. A person learns the basic norms of morality in the process of education and perceives following them as his duty. Hegel wrote: “When a person performs this or that moral deed, then by this he is not yet virtuous; he is virtuous only if this mode of behavior is a constant feature of his character.
On this occasion, Mark Twain noted that “we do not use our morality very well on weekdays. By Sunday, it always needs repair.
A morally developed person has a conscience; the ability to independently judge whether his actions correspond to moral norms accepted in society, and is guided by this judgment when choosing his actions. Moral principles are especially necessary for those specialists whose object of communication is people.
Some authors believe that there is no special medical ethics, that there is ethics in general. However, it is wrong to deny the existence of professional ethics. After all, in each specific sphere of social activity, the relations of people are specific.
Each type of work (doctor, lawyer, teacher, artist) leaves a professional imprint on the psychology of people, on their moral relationships. Interesting thoughts about the connection between moral education and the professional division of labor were expressed by Helvetius. He said that in the process of education it is necessary to know "what talents or virtues are characteristic of a person of a particular profession."
Professional ethics should be considered as a specific manifestation of general ethics in the special conditions of a particular activity The subject of professional ethics is also the study of the psycho-emotional features of a particular specialist, manifested in his relationship with sick people (disabled people) and with his colleagues against the background of certain social conditions.
The peculiarities of the professional activity of a doctor determine that in medical ethics, to a relatively greater extent, in any case, more than in the ethical standards that regulate the activities of people in other professions, universal norms of morality and justice are expressed.
The norms and principles of medical ethics can correctly guide a medical worker in his professional activity only if they are not arbitrary, but scientifically substantiated. This means that various recommendations regarding the behavior of doctors, medical practice, need theoretical
Medical ethics should be based on a deep understanding of the laws of the natural and social life of man. Without a connection with science, moral norms in medicine turn into groundless compassion for a person. The doctor's true compassion for the sick (disabled person) should be based on scientific knowledge. In relation to the patient (disabled), doctors should not behave like inconsolable relatives. According to A.I. Herzen, doctors "can cry in their hearts, take part, but understanding, not tears, is needed to fight the disease." To be humane in relation to sick people (disabled people) is not only a matter of the heart, but also of medical science, medical reason.
Some of the failed physicians are so skillfully attuning their behavior to the needs of medical ethics that it is almost impossible to reproach them for not having a vocation for medicine. We are talking about “that coldly businesslike accounting, indifferent attitude to the most acute human tragedies,” wrote the famous Russian surgeon S.S. Yudin, - when behind the guise of so-called professional restraint and restrained courage, they actually hide egoistic insensitivity and moral apathy, moral squalor.
The most important principles of medical ethics

1. A humane attitude towards the patient (disabled person), expressed in the readiness to always come to the aid of everyone in need, in the need to comply with the Hippocratic requirement - not to harm, spare the psyche of the patient (disabled person), try not to hurt him.
2. Compliance of the actions of a doctor with a public function, with the goals and objectives of medicine, according to which the doctor, under no pretext, can participate in actions directed against physical and mental health and life.
3. The duty of the doctor is to fight for the physical and mental perfection of people. Self-sacrifice and heroism in the name of human health and life should be the rule of medical behavior.
4. The doctor's duty is to help everyone, regardless of gender, nationality, race, political or religious beliefs.
5. The principle of solidarity and mutual assistance among all doctors.
6. The principle of maintaining medical secrecy.

Many of the listed principles are universal, i.e. are characteristic of the activities of any specialists who communicate with people, including the sick and disabled.
The problem of the relationship between the doctor and the patient (disabled person) has always been an important problem in medicine at all stages of its development.
Already in the ancient manuscripts of Egypt and India, there are indications of what a doctor should be in terms of his moral qualities, what rules he should be guided by in his attitude towards patients and colleagues. An ancient Indian saying says: “For the sick, the doctor is a father; for the healthy, he is a friend. When the disease has passed and health has been restored, he is a guardian.
A very curious prayer of a doctor dating back to the 12th century has been preserved. It says: “Give me love for people, deliver me from covetousness, vanity, so that they do not mislead me and do not interfere with benefiting people, save me the strength of my body and my soul so that I can help the poor and the rich, the good and evil, enemy and friend, may I always see only a person in every suffering person.
Questions of medical ethics also occupied a prominent place in the history of Russian medicine. For the first time, medical activity in Russia was regulated under Peter I. Already in his first decrees, attention is drawn to what ethical considerations doctors should be guided by in the performance of their duties. One of Peter’s decrees says: “So that a doctor in the doctorate has a good foundation and practice, keeps himself sober, moderate and well-meaning and, in necessary cases, can perform his rank both night and day ... Every doctor has the first duty to be a philanthropist and in any case be ready to give help to people who are obsessed with diseases.
The best representatives of Russian medicine Zybelin, Mudrov, Botkin and others in their writings paid much attention to the behavior of a doctor, to those moral qualities that are necessary for him to enjoy authority. The famous Moscow doctor Haaz at the beginning of the 19th century. wrote: “The surest way to happiness is not in the desire to be happy, but in making others happy. To do this, you need to listen to the needs of people, take care of them, not be afraid of work, helping them with advice, in a word, love them, and the more often you show this love, the stronger it will become.
Every profession requires a calling. This is especially necessary for professionals working with people. The great Russian clinician Mudrov believed that acquiring the profession of a doctor should not be a matter of chance, but a vocation. He wrote: "A mediocre doctor does more harm than good: patients left without his medical care can recover, and those used by this doctor die."
The well-known domestic writer K. Paustovsky described the concept of “vocation” as follows: “Medicine is not a craft and not an occupation, but the fulfillment of a duty. Medicine is a calling to fulfill one's duty." Let me remind you that the word "calling" comes from the word "call".
Honesty, truthfulness, spiritual purity, a sense of moral responsibility to one's conscience, team, society - this is the main thing that measures the requirements for any specialist, what determines the measure of their value, their understanding of their duty.
Issues of deontology should be considered in terms of the implementation of the principles of behavior of certain specialists in their professional activities. In this regard, the importance of obscheetichss-k.di k.ik-yuri debt. “We always have one anchor from which, if you don’t m> "n them., You will never break - a sense of duty" (I.S. Turgenev). each person in front of others: "The purpose of life is good. Living for others seems difficult just as hard to work. The more you serve others (with effort), the more joyful, the more you serve yourself (without effort), the harder life is." W. Goethe owns wonderful words: "Duty is love for what you order yourself. How can you know yourself? Not through contemplation, but only through activity. Try to fulfill your duty, and you will find out what you have."
The duty in general, and the duty of any specialist in particular, is, above all, to do his duty honestly and well. The explanatory dictionary states that "honor is the internal moral dignity of a person, valor, honesty, nobility of soul and a clear conscience."
The basis of the behavior of any specialist should be the requirements of humanism. Hence, his highest moral duty must find its manifestation in selfless service to people. In a moral duty, the need for love for a person must be expressed. At the same time, in the activities of any specialist, it is especially important that the fulfillment of duty is organically combined with inner conviction, which turns into habitual everyday behavior. “The moral qualities of a person must be judged not by his individual efforts, but by his daily life” (Pascal).
Doing your duty as a doctor is no easy task. The fulfillment of duty requires certain efforts, because the doctor's duty and personal desires do not always coincide. “Man lives on earth not to become rich, but to become happy” (Stendhal). Highly moral character is the highest goal of human aspirations.
The fulfillment of medical duty involves the conviction of the need to subordinate one's personal desires to the requirements of duty. In life, it also happens that a doctor has to sacrifice personal interests if this is necessary to save the lives of others. ON THE. Dobrolyubov said: “It is not the one who should be called a truly moral person who only endures the dictates of duty over himself, like some kind of heavy yoke, like moral chains, but precisely the one who cares to merge the demands of duty with the needs of his being, who tries to rework his own flesh and blood by the internal process of self-consciousness and self-education so that they not only become truly necessary, but also bring inner pleasure.
Some wise sayings:
“Only he lives freely who finds joy in the performance of his duty” (Cicero);
"Duty! You are an exalted great word. This is that great thing that elevates a person above himself ”(E. Kant);
“There is no other greatness, except the greatness of the fulfilled duty, there is no other joy” (E. Renan).
The modern development of medical technology, laboratory and instrumental methods of research leads to the replacement of direct contacts "doctor - patient" with the relationship "doctor - patient device". There is a fear that the doctor, trusting technology, ceases to improve his knowledge, that technization can affect the relationship between the doctor and the patient and lead to a violation of the optimal psychological contact between them. Therefore, the high culture of the doctor, the combination of developed clinical thinking and modern scientific knowledge acquire an emphasized deontological significance. The device should not obscure the identity of the patient.
“The crisis of man ... is not rooted in human nature itself; it is not some inherent property of it...; no, it is rather a crisis of civilization or culture, which is the cause of a deep discrepancy between the thinking and behavior of a person, on the one hand, and the changing real world, on the other. And this crisis - for all its depth and danger - can still be overcome” (A. Peccei).

11.3. Personality (doctor's authority)

A person who thinks only of himself and seeks his own benefit in everything, fie can be happy. If you want to live for yourself, live for others.
Seneca

The doctor's authority plays an important role in establishing optimal psychological contact with the patient, and therefore largely determines the effectiveness of treatment. At all stages of healing, good contact established between the patient and the doctor is extremely important. The lack of such contact can be one of the main reasons for misdiagnosis and unsuccessful treatment. The doctor must be trusted wholeheartedly. It is very difficult to treat a doubting patient. V.V. Veresaev pointed out that “a doctor can have a remarkable talent for recognition, be able to capture the most subtle details of his appointments, and all this will remain fruitless if he does not have the ability to subdue the soul of the patient.” Thus, there is no doubt that the psychological compatibility of the doctor and the patient plays a leading role in the healing process.
In this regard, the need to win the trust of the patient is of great importance. The prerequisites for the emergence of a positive psychological relationship between the doctor and the patient are, of course, the qualifications, experience and skill of the doctor. However, qualifications serve only as a tool, the use of which, with greater or lesser effect, depends on other aspects of the doctor's personality. This comes from the trust in the doctor. After all, “the doctor is the only person to whom, without embarrassment, we dare to tell everything about ourselves” (Moore).
Trust in the doctor is a dynamic, positive attitude of the patient towards the doctor, when the patient sees that the doctor has not only the ability, but also the desire to help him in the best possible way. In the process of treatment, the patient must become an ally of the doctor. M.Ya. Mudrov in his work “A word about the way to teach and learn medicine” wrote: “Now you have experienced the disease and know the patient, tell me that the patient has tested you and knows what you are. From this you can conclude what patience, prudence and mental exertion are needed at the bedside of a patient in order to win all his trust and love for himself, and this is the most important thing for a doctor.
The authority of a doctor is the result of high medical professionalism, high moral qualities and high culture.
Of course, any specialist must have good knowledge and extensive professional experience. High professionalism requires a lot of systematic work. The whole life of any specialist is a constant improvement of their knowledge. However, the development and education of any person can not be ladies or communicated. Therefore, anyone who wants to partake of them must achieve this by his own activity, his own strength, his own effort. The Polish physician Kslanovich writes that a doctor who does not look into books should be more wary of illness. An important task in the learning process is to teach a person to think. A.M. Gorky said: "Knowledge is necessary not only to know, but to act meaningfully."
Only in work, in overcoming obstacles, professional knowledge and skills, real character are formed, high morality is brought up for life. A person must educate himself. Only then is a constant, meaningful psychological readiness developed to act as conscience dictates, a sense of duty dictates. Of course, a solid layer of professional knowledge and experience is needed. “Mind consists not only in knowledge, but also in the ability to apply knowledge in practice” (Aristotle).
A medical worker acquires the trust of patients if he, as a person, is harmonious, calm and confident, but not arrogant, and if his demeanor is persistent and resolute, accompanied by human participation and delicacy. The need to be patient and self-controlled makes special demands on him.
The balanced personality of a doctor is for the patient a complex of harmonic external stimuli, the influence of which takes part in his recovery. In general, it can be said that the patient loses confidence, and the doctor loses his authority if the patient has the impression that the doctor is what is called a "bad person". Is it not about such doctors that Voltaire said: “Doctors prescribe medicines about which they know little, for diseases in which they understand even worse, and stuff them with people about whom they know nothing at all.”
The circumstances of the work force the doctor to be a kind of actor. Whatever the patient, for the doctor is not only a new disease, unique in details, but also a special personality. What range of temperaments, characters; everyone has their own mindset. And the doctor should have a special approach to each. In this regard, the words of K.S. Stanislavsky: “... Playing with a full and sympathetic audience is the same as singing in a room with good acoustics. The viewer creates, so to speak, spiritual acoustics. He receives from us and, like a resonator, returns to us his living human feelings.
It is very important for a doctor to know those reactions of the patient's personality that are formed during the illness. Therefore, doctors should be good psychologists and psychotherapists. There is no doubt that the disease affects the psyche of patients to a certain extent. Each patient has his own psychology, his own attitude towards others, himself and his illness. It is no coincidence that Academician Mirotvortsev once said that "there are no greater egoists than the sick...". Consequently, if mental factors are of such great importance in medical activity, then it is necessary to deal with the methods of their cognition. As G.A. Zakharyin: "... the doctor should shine the psychological portrait of the patient."
Attaching great importance to the state of the nervous system and psyche in resistance to pathogenic influences, one must carefully treat the sick. It is recommended not to injure or frighten the patient, to calm the excited nervous system and to subject the patient to his psychotherapeutic influence.
A sick person is waiting for affection and consolation, and sometimes tenderness. At the same time, to be humane to people, to the patient is a matter not only of the heart, but also of the mind. Zweig's discussion of the different types of compassion is interesting. He writes: “...there are 2 kinds of compassion. One is cowardly and sentimental, it is, in essence, nothing more than the impatience of the heart, in a hurry to get rid of the painful sensation at the sight of someone else's misfortune, this is not compassion, but only an instinctive desire to protect one's peace from the suffering of the patient. But there is another compassion - true, which requires action, not sentimental experiences, it knows what it wants and is determined, suffering and compassionate, to do everything that is in human strength and even beyond them.

A sick person, to a much greater extent than a healthy person, is susceptible to various kinds of inspiring influences. Even a careless gesture by a doctor can cause a patient to have a distorted idea of ​​the severity of the disease, and an encouraging word can inspire faith in recovery. “If after a conversation with a doctor the patient does not feel better, then this is not a doctor” (Bekhterev).
Unfortunately, there are still doctors who are unworthy of the humane medical profession. A.P. Chekhov paid much attention to the issues of medical deontology. However, defending medicine, doctors, did this mean that all doctors were some kind of living embodiment of the commandments of Hippocrates? Such serene goodness would not be in the Chekhovian spirit at all. Everyone will immediately remember Ionych, Dr. Chebutylk and Na from The Three Sisters, a whole gallery of other characters in his stories. Chekhov is far from striving to defend the honor of his uniform at all costs and does not share the views of the prosector Pyotr Ignatievich from "A Boring History", according to whose deep conviction "the best spider is medicine, the best people are doctors, the best traditions are medical" . He saw enough among doctors both ignoramuses and boors, as well as among people of other professions. If a doctor is not only a knowledgeable person, but also a resolute, sincere person, who takes the grief and suffering of his patient close to his heart, then the charm of personality is added to his professional art. The authority of such a doctor, faith in him have a beneficial effect on the state of health of the patient, strengthens his will. Y. German in his work “The Cause You Serve” wrote: “A doctor should not be boiled beef, but an energetic, strong person who is pleased to obey. You are obliged to be a moral hero, a legend, a fairy tale, and not oatmeal jelly ... You are also obliged to act with your personality, and not only sweat or potions.
Character traits that contribute to the authority of the doctor
The nobility of the soul. “Those of people are glorified among the people who are noble in nature” (Ibn Sipa).
The ability not only to teach others, but also to encourage them. “Encouragement after censure is like the sun after rain” (W. Goethe).
Before giving advice to others, know yourself. “First of all, teach yourself, then you will learn something from others” (W. Goethe).
Mandatory. “When a person performs this or that moral deed, then by this he is not yet virtuous; he is virtuous only if this mode of behavior is a permanent feature of his character” (Hegel).
Appearance, behavior of the doctor, his manner of talking with the patient. A good demeanor, a calm, confident voice of a doctor are important conditions for his authority. Remember that "behavior is a mirror in which everyone shows his image" (W. Goethe). Do not rush, rush when communicating with the patient. “Be wise: those who are in a hurry are in danger of falling” (W. Shakespeare).
Ease of communication. “Simplicity is not only the best, but also the noblest” (Fontane).
Purposefulness, conviction. “A person who changes his views to please the first person we meet, we recognize as trashy, vile, without any convictions” (N. Dobrolyubov).
Principle. “Whoever does not understand the principles in all their logical completeness and consistency, has not only confusion in his head, but also nonsense in his affairs” (N. Chernyshevsky).
Conscience, honor. The development of a sense of conscience always helps to fulfill one's duty, warns him against wrong, immoral actions, prompts honest, worthy and fair actions. “The law that lives in us is called conscience; conscience is, in fact, the application of our actions to this law ”(E. Kant).
Be true, be true! * Wisdom is only in truth” (W. Goethe).
Sympathy. “Sympathy creates trust, and trust is the key to the heart” (Wodenstaedt).
Strength of character. “The greatest firmness is the greatest mercy” (W. Goethe).
Shyness. “Shame sometimes forbids what laws do not forbid” (Seneca).
Generosity, self-control, patience. “Patience is the art of hoping” (Schleiermacher).
Honesty. “An honest man, sitting in a judicial chair, forgets about personal sympathies” (Cicero).
Justice. “There are two principles of justice: not to harm anyone and to benefit society” (Cicero).
Strict adherence to the principles of deontology and medical ethics. “Do to the patient only what you would do exactly in this case to yourself or your loved one” (N. Petrov).
Clear statement of the task and control of its performance. Remember that "advice is like castor oil: it's pretty easy to give, but damn unpleasant to take" (B. Shaw).
Wisdom, which is the daughter of experience. “If you want to be smart, learn to ask intelligently, listen carefully, answer calmly, and stop talking when there is nothing more to say” (Lavater).
Compassion, mercy, kindness. “Kindness is a quality, the excess of which does not harm” (D. Galsworthy).
Truthfulness, philanthropy, kindness. “Kindness is the most necessary seasoning for everything. The best qualities are worthless without kindness” (L.N. Tolstoy).
Modesty, selflessness. “Be humble—this is the kind of pride that irritates those around you the least” (Cervantes).
Some character traits that negatively affect the authority of the doctor
Ignorance, low professional and moral qualities.
Cowardice. “Cowardice is the lot of the insignificant. The one whose heart is firm, whose actions are done in accordance with his conscience, will uphold his principles until the end of his life ”(Payne).
Dishonesty, dishonesty, deceit. “The father of lies is undoubtedly the devil, due to negligence he did not patent his idea, and now his enterprise is suffering greatly from competition” (B. Shaw).
Unscrupulousness, arrogance, stubbornness. “Only the foolish and the dead never change their minds” (Lowell).
Rudeness, tactlessness. "Anger is short-term madness" (Horace).
impoliteness. “Impoliteness between equals is ugly, but on the part of the authorities it is tyranny” (Lope de Vega).
Ambition, vanity. “Ambition is indiscretion of mind” (Devenanat). “Pride that dines with vanity gets scorn for dinner” (Franklin).
Cynicism. “A cynic is a human owl, awake in the dark and blind in the light, hunting for carrion and neglecting noble game” (Beecher).
Hypocrisy. “Flattery is a counterfeit coin that circulates only thanks to our vanity” (Larachefuk).
Carelessness, indifference.
Arrogance, stubbornness. “The arrogant and stubborn one does everything in his own way, does not listen to anyone's advice and soon becomes a victim of his delusions” (Aesop).
Injustice, dishonesty, cowardice, indiscretion. “A lack of modesty is a lack of intelligence” (A. Paul).
Selfishness. “Personal egoism is the father of meanness” (M. Gorky).
Inhumanity, indiscretion, meanness, boasting. “Do you want people to believe in your virtues? Do not brag about them ”(B. Pascal).
Verbosity, talkativeness. “Those who cannot think are talkative” (R. Sheridan).
Intemperance, deceit, laziness, weakness of character, boastfulness.
Anger, pessimism, envy, haste in conclusions, haste in judgments and actions, frivolity, cowardice, greed, rudeness, arrogance.
Ambition. “Insatiable ambition darkens the mind of a person, and he does not notice the dangers that threaten him” (Aesop).
Narcissism. “A narcissist is a cross between a fool and an impudent person, he has something of both” (J. La Bruyère).
Stubbornness.
The lack of optimal contact between the doctor and the patient has a negative impact on the psychological and somatic state of the patient and can be a source of conflict situations. Let us recall the illness of Kitty Shcherbatskaya, brilliantly described in the novel by L.N. Tolstoy "Anna Karenina". The visit of a well-known professor, who violated all the principles of deontology and medical ethics, led not only to the absence of contact with Kitty, but also to complete hostility towards him. As a result, after the inspection, “Kitty was standing in the middle of the room. When the doctor came out, she flushed, and her eyes filled with tears. Her whole illness and her treatment seemed such a stupid, even ridiculous thing, her treatment seemed to her as ridiculous as putting together pieces of a broken vase. Her heart was broken. Why do they want to treat her with pills and powders.
The fate of every person is often in his character. The character of each person has an influence on the happiness of other people, depending on whether it has the property to bring harm or benefit.
The well-known domestic therapist Kassirsky wrote: “A person who has entered the path of a doctor must be a bearer of high moral and ethical qualities. A young doctor has to pass two tests in life: the test of success and the test of failure. The first threatens with self-delusion, the second - with the surrender of the spirit: fortitude in the face of these trials depends on the personality of the doctor, his ideological principles, beliefs and moral ideals.
The authority of any specialist wins in many respects if he is not afraid of responsibility. He who is afraid of responsibility cannot decide the fate of people. A person achieves the highest success when he sets a good example. No one should give advice to others that he himself does not follow. The personal example of a doctor is always more powerful than a sermon. “Follow my deeds, not my words” (Titus Livius). In this regard, the words that the teacher is not the one who teaches, but from whom they learn are quite fair.
Of great importance is the ability to eliminate their mistakes and shortcomings. Authority wins in many respects if mistakes are recognized in a timely manner, corrected and not repeated. It should be remembered that it is easy to move from small mistakes to major vices. Consciousness of one's mistake is one of the main means of self-education and a lesson for others. A thinking person draws as much knowledge from his mistakes as from his successes. Stubbornness is an unwillingness to correct one's mistakes and listen to the opinions of other people.

11.4. Physician Culture

Art has a moral effect not only because it gives pleasure through moral means, but also because the pleasure delivered by art serves as the very path to morality I.F. Schiller
Professionals who have constant contact with healthy and sick people (disabled) should be carriers of a high culture, remembering that "culture and external gloss are completely different things" (Emerson).
For all specialists, the desire to know everything beautiful and sublime should become natural. “The decisive and defining quality of clinical work is not the research methodology, but the culture of the doctor’s own personality” (Bilibin). All this is necessary as one of the conditions for effective professional activity.
Empathy, excitement when touching the world of art (painting, music, theater, works of classical literature) - this is a comprehensive development of the personality, the formation of high morality, effective contact with the sick (disabled person). Art brings harmony to the personality of this or that specialist, accelerates the search for the right solutions, it would seem, in hopeless situations, calms, resolves spiritual conflicts. A sense of beauty protects a specialist from extremes, rationalism, enlivens his creative powers, activates thought, and humanizes professional activity. It is mental culture that provides refined feelings. “An enlightened mind ennobles moral feelings: the head must educate the heart” (Schiller).
If a doctor ceases to be interested in poetry, music, the humanities, then there is no doubt that his interest in the world around him, in particular, in a sick person, is fading. Indifference to works of art weakens the feeling of empathy, contributes to the emergence of such negative moral qualities as rudeness, he will perceive the suffering of the patient only with his mind. In this regard, the words of the famous Russian artist Levitan that “a sick heart can be treated only with the heart” are very consonant.
Sidenagam, this English Hippocrates, was once approached by a young physician with a request for advice on what books to read in order to become a good doctor. “Read, my friend, Cervantes' Don Quixote is a wonderful, kind book, which I myself often re-read,” replied the famous doctor.
A doctor, communicating with patients (disabled), who are representatives of various segments of the population, must be comprehensively prepared in order to always find a common topic for conversation, which could become a prerequisite for successful treatment.
In the formation of the moral character of doctors, the upbringing of a culture of feelings, and in particular, familiarization with the world of beauty, is of great importance. As Aristotle pointed out, "... music is capable of exerting a certain influence on the ethical side of the soul." V.F. Odoevsky said that "music is more connected with the moral deeds of a person than is usually thought."
For a doctor, the ability to perceive the phenomena of art is important as one of the means of forming clinical thinking. D. Diderot wrote: “Imagination! Without this, one cannot be either a poet, or a philosopher, or an intelligent person, or a thinking being, or just a person. Imagination is the ability to evoke images. A person completely devoid of this ability would be stupid. Developing imagination, intuition, fantasy, active artistic perception develops the skills to think associatively. A doctor, as noted by the famous domestic surgeon N. Burdenko, with a vivid imagination makes mistakes less often than an honest pedant and only a hardworking researcher. Passion for one-sided practical or scientific activity, as a rule, leads to one-sided development of the personality and is condemned even by those specialists who themselves did not escape such one-sidedness in their intellectual development, although they were able to achieve outstanding success on the beer of science. Charles Darwin recalls, not without regret, that he “almost lost his artistic taste for pictures and music, and therefore, if he could start his life over again, he would make it a rule to read at least once a week some poetic work or listen to good music. He believed that "the loss of susceptibility to such things is the loss of happiness, it is possible that it has a harmful effect on the intellect, and, in any case, it brings irreparable damage to the development of human morality, weakening its emotional side."
Prominent domestic surgeon S. Yudin emphasized that “Monotonous work without the life-giving jolts of poetry, art and travel creates calm, a habit of dilapidated antiquities, reconciliation with vulgarity and petty goals, that in such conditions not an interest in life is gradually developed, but an interest in its ghosts: material wealth, money, ranks, orders and gossip. We have seen so many times how promising even bright talents faded and went out, how they died not from alcohol - this most terrible scourge of the former Russian reality, but from boredom and monotony.
There are people who judge medicine no worse than the sick, because they themselves have been visited by ailments more than once, and at the same time understand no less than doctors, since they personally listened to patients and sat at the bedside of the afflicted. They strive to tell others about all this, and the more accessible, the better. These people are writers and doctors. As André Maurois rightly said at the International Congress of Physicians in Paris: “There is a deep kinship between writers and doctors, since both of them treat human beings with passionate attention, and both of them forget about themselves for the sake of people.” Therefore, it is no coincidence that doctors were such great writers as Rabelais, Schiller, Mauroy, Copan Doyle, Chekhov, Veresaev, Bulgakov, and others. In one of the essays, Andre Maurois wrote: "A great writer must cover all aspects of human existence."
See how the classics of Russian literature, being not physicians, so fully, vividly, deeply, but at the same time simply and naturally presented a description of a number of painful conditions. Recall the novel by I.S. Turgenev "Fathers and Sons" or the story of D.V. Grigorovich "The Dream of Karenin". In the story of L.N. Tolstoy "The Death of Ivan Ilyich" describes the inner world of a patient suffering from cancer. A.I. Kuprin in the story "At the Circus" perfectly described the clinical picture of an attack of angina pectoris (angina pectoris) in a circus athlete.

1. P. Chekhov said that "a real writer is the same as an ancient prophet: he sees more clearly than ordinary people."
2. V. Veresaev studied at the St. Petersburg University at the Faculty of History and Philology. In 1888, he entered the Faculty of Medicine at Dorpat University. In his Autobiography, he later explained his desire to become a doctor: “My dream was to become a writer, and for this it seemed necessary to know the biological side of man, his physiology and pathology; in addition, the specialty of a doctor made it possible to closely converge with people and .imch of various strata and ways. He further said: “Since then, it’s been more than two centuries since then: medicine has taken a giant step forward, in the past it has become a science, and yet what an enormous area of ​​​​osmosis is in it, where even at the present time the best teachers are Cervantes, Shakespeare, Tolstoy, who have nothing to do with medicine.”

A deep knowledge of life in all its manifestations, combined with the greatest and inquisitive observation, allowed writers who did not know medicine to describe the clinical picture of a number of morbid conditions quite clearly and clearly.
9 years before Veresaev began his "Doctor's Notes", in 1886, in Moscow, a cast-iron plate "Doctor Chekhov" appeared on the doors of a two-story mansion. The future writer considered medicine the main thing in his life. He valued and was proud of the title of doctor. When the Russian Academy of Sciences elected him an honorary member, he wrote to his wife Olga Leonardovna Knipper, an actress of the Moscow Art Theater: “... I wanted to first make you the wife of an honorary academician, but then I decided that it would be much more pleasant to be the wife of a doctor.”
A.P. Chekhov created exceptionally accurate and vivid prose, in which artistic and scientific medical elements merged. The French physician Henri Bernard Duclos devoted his doctoral dissertation to the topic "Anton Chekhov - doctor and writer".
“In Chekhov's work,” Duclos wrote, “there are many patients, there are descriptions of individual cases, and clinical observations. But we are not interested in pathological and epidemiological details, but in the ability with which Chekhov, with a few strokes, a few words, without even resorting to scientific terms, enables the medical reader to recognize the symptoms of the disease and make a diagnosis ... It is not enough for a writer to see people, he must be able to observe and grasp their most important features.
In conclusion of this chapter, it is appropriate to quote the words of N.G. Chernyshevsky: "Scholarly literature saves people from ignorance, and elegant literature from rudeness and vulgarity."

11.5. Conditions conducive to optimal psychological contact between a doctor and a patient (disabled person)

When a person does not know which pier he is on his way to, not a single wind will be favorable for him.
Seneca

These conditions include:
1. The authority of a specialist who must be trusted undividedly. The specialist is obliged not only to dispel the doubts and fear of the patient (disabled person), to give hope, but also to be able to hide his grief and discontent, to show calmness and self-control. In relation to each patient (disabled person), the reaction of a specialist should be quick, sometimes almost instantaneous, and the solution of the issue should be extremely accurate. The authority of a specialist is the result not only of high professional and moral qualities, but also of a great culture.
“An enlightened mind ennobles moral feelings: the head must educate the heart” (Schiller). A specialist, communicating with patients (disabled people), who are representatives of various segments of the population, must be comprehensively prepared in order to always find a common topic for conversation, which could become a prerequisite for successful contact.
Cases of a conflict situation in the relationship between a specialist and a patient (disabled person), unfortunately, still occur. The conflict process is usually two-sided. Sometimes the sick (disabled) can also be guilty. If a specialist is a well-mannered and educated person, if he is a good psychologist, then he should have enough prudence and tact in dealing with the so-called conflict patients (disabled people). And vice versa, if he does not find a common language with a sick (disabled person), conflicts, if they complain about him, then this is direct evidence that there are serious problems in his education or upbringing.

• Finding a common language with a sick (disabled person) is sometimes not easy: sometimes only kindness and cordiality, courtesy and attention do not help. In these cases, the specialist should draw the attention of the patient (disabled person) to some unusual side of his knowledge, unobtrusively show the patient (disabled person) such a good awareness of non-medical issues that he, considering himself a stock of them, did not expect to find them from a specialist.

Some advice in the form of sayings of wise people in order to have a full conversation with the sick (disabled):
“Let me speak freely if you want to hear the truth!” (Public Sir);
“Talk less about theories with ordinary people, and do more according to them” (Epictetus);
“Live with people so that your friends do not become enemies, and enemies become friends” (Pythagoras);
“He who is so deaf that he does not even want to hear the truth from a friend is hopeless” (Cicero);
“There is only one way to become a good interlocutor - to be able to listen” (K. Marley);
“Having silenced a person, you have not yet convinced him” (K. Marley).

• Trust in a specialist is a dynamic, positive attitude of the patient (disabled person) towards him, due to the expectation that the specialist has the ability, means and desire to help the patient (disabled person) in the best possible way. As Bedengithedt said, "sympathy breeds trust, and trust is the key to the heart."

A medical worker gains confidence in patients (disabled and in other cases, if he, as a person, is harmonious, calm and confident but not arrogant, and if his demeanor is persistent, quick and decisive, accompanied by human participation and dividing by six The doctor is obliged to subjugate the soul of the patient.

• Non-standard, individual approach (conversation) to patients (disabled people). Whatever the patient (disabled), for the specialist is not only a new, unique in details disease (disability), but also a special personality. Everyone has their own mindset. People are different in age, education, upbringing, profession. And the specialist should have a special approach to each of them.

Every person has his own temper, And the healer will be right, Kohl, studying the properties of these and these, Keep anyone in mind.
Ibn Seema

• The need to take into account the peculiarity of the psyche of the patient (disabled person). It is no coincidence that Academician Mirotvortsev said: "There are no greater egoists than the sick." There is no doubt that the disease (disability) affects to a certain extent the psyche of the patient (disabled person). Hence the various psychological reactions to illness (disability). Attaching great importance to the state of the nervous system, one must carefully treat the sick (disabled). It is recommended not to injure or frighten patients (disabled people), to calm their excited nervous system and to subordinate the patient (disabled person) to their psychotherapeutic influence,

There are people who judge medicine well - these are writers. A.P. Chekhov could look at medicine from three points of view - the writer, the doctor and the patient. In his works, he paid much attention to mental suffering, the “spiritual” pain of a person. Practical medical activity helped him in a number of novels and stories to describe the inner world and psychology of a sick person. A.P. Chekhov describes two aspects: the influence of bodily pain on the patient's psyche (the stories "A Boring Story", "Compensation Disorder", "Case from Practice", etc.) and the influence of the psyche on the development of a bodily disease (the stories "Gusev", "Spouse", etc. .).
Each patient (disabled person) has his own psychology, his own attitude to the environment, to himself and his illness (disability). Therefore, every specialist working with people must be a good psychologist. If these principles are not observed, medical errors and conflict situations arise. An example is the case history of Natasha Rostova, the heroine of the novel War and Peace. L.N. Tolstoy brilliantly described Natasha's mental illness, caused by a quarrel with Prince Bolkonsky, which doctors mistakenly regarded as a bodily illness.

• A sick person is much more susceptible than a healthy person to inspiring influences of various kinds, both positive and negative. A careless gesture by a doctor can cause a patient to have a distorted idea of ​​the severity of the disease, and an approving word, on the contrary, can inspire faith in healing.

The doctor's word acts as a material means. “The word for a person is the same real stimulus as all the others, and therefore it can cause all those reactions of the body, as well as to any real stimulus” (IP Pavlov). The word heals and the more effective, the more significant the personality of the doctor. Bernard Shaw said that "there are 50 ways to say the word 'yes' and 50 ways to say the word 'no'. However, one should also remember that “the word hurts faster than it heals” (Goethe). Violations of the principle of an individual approach to patients (disabled people) without taking into account their psychological portrait, especially a careless word, tone, and the like, can be a source of so-called iatrogenic diseases, i.e. diseases "born a doctor". Words can hurt a person and cause sickness, and words can cure a sick person. This idea is especially well expressed in Chekhov's story "The Wolf".
Panaev in his literary memoirs cites the following historical case. The famous doctor Spassky was returning from the dying Pushkin. The patient, to whom he then came, was in a very serious condition. He asked the doctor, “Tell me, is there any hope, doctor? Can I get well? "None," Spassky replied. - "Yes, what is it!" “Everyone dies, father. Here Pushkin dies. Do you hear? Pushkin! So already you and I can die, ”The patient with a groan lowered his head onto the pillow and died almost at the same hour as Pushkin.
Another example. “Z goes to the doctor,” Chekhov describes a case taken from medical practice, “he listens, finds a heart defect. Z abruptly changes his lifestyle, speaks only about his illness, the whole city knows that he has a heart defect ... he does not marry, refuses amateur performances, does not drink, walks quietly, barely breathing. Eleven years later he goes to Moscow, goes to the professor. This one finds a perfectly healthy heart. Z is happy, but he can no longer return to normal life, because he is used to going to bed with chickens and walking quietly, and it is already boring for him not to talk about his illness. I just hated doctors, and nothing more.
The success of the conscious implementation of recommendations and advice is due to the unity of views and actions of a specialist and a patient (disabled person). The unity of spirit, views, will, action - only this is true unity, although unity does not always mean complete uniformity. Where there is no community of interest, there can be no action. “An individual is weak, like an abandoned Robinson, only in society with others can he do a lot” (Schopenhauer).

Control tasks

• Principles of medical deontology.
• Principles of medical ethics.
• Personality traits of a doctor that determine his authority.
• The value of culture for the professional activities of a doctor.
• Conditions conducive to optimal contact between a doctor and patients (disabled people).

Deontology and ethics in medicine have always been of great importance. This is due to the specifics of the work of the staff of medical institutions.

Fundamentals of medical ethics and deontology today

At present, the problem of relationships (both within the workforce and with patients) has acquired particular importance. Without the coordinated work of all employees, as well as in the absence of trust between the doctor and the patient, it is unlikely that serious success will be achieved in the medical field.

Medical ethics and deontology are not synonymous. In fact, deontology is a kind of separate branch of ethics. The fact is that it is an inferior complex of only a professional person. At the same time, ethics is a much broader concept.

What can be deontology?

Currently, there are several variants of this concept. It all depends on what level of relationship is being discussed. Among their main varieties are:

• doctor - patient;
• doctor - nurse;
• doctor - doctor;
• - patient;
• nurse - a nurse;
• doctor - administration;
• doctor - junior medical staff;
• nurse - junior medical staff;
• junior medical staff - junior medical staff;
• nurse - administration;
• junior medical staff - patient;
• junior medical staff - administration.

The doctor-patient relationship

This is where medical ethics and medical deontology matter most. The fact is that without their observance, a trusting relationship is unlikely to be established between the patient and the doctor, and in fact in this case the process of recovery of a sick person is significantly delayed.

In order to win the patient's trust, according to deontology, the doctor should not allow himself unprofessional expressions and jargon, but at the same time he should intelligibly tell the patient both about the essence of his disease and about the main measures that must be taken in order to achieve a full recovery. If the doctor does just that, then he will definitely find a response from his ward. The fact is that the patient will be able to trust the doctor 100% only if he is really confident in his professionalism.

Many doctors forget that medical ethics and medical deontology forbid confusing the patient and are expressed in an unnecessarily complicated way, not conveying to the person the essence of his condition. This gives rise to additional fears in the patient, which by no means contribute to a speedy recovery and can be very detrimental to the relationship with the doctor.

In addition, medical ethics and deontology do not allow the doctor to talk about the patient. At the same time, this rule should be followed not only with friends and family, but even with those colleagues who do not take part in the treatment of a particular person.

Interaction between nurse and patient

As you know, it is the nurse who has more contact with patients than other healthcare workers. The fact is that most often after a morning round, the doctor may not see the patient during the day. The nurse, on the other hand, delivers pills to him several times, makes injections, measures blood pressure and temperature, and also performs other appointments of the attending physician.

The ethics and deontology of the nurse requires her to be polite and responsive to the patient. At the same time, in no case should she become an interlocutor for him and answer questions about his illnesses. The fact is that a nurse may misinterpret the essence of a particular pathology, as a result of which the preventive work carried out by the attending doctor will be harmed.

Relationships between nurses and patients

It often happens that it is not the doctor or the nurse who is rude to the patient, but the nurses. This should not happen in a normal health care facility. Nursing staff should take care of patients, doing everything (within reason) to make their stay in the hospital as convenient and comfortable as possible. At the same time, they should not enter into conversations on distant topics, and even more so answer medical questions. Junior staff do not have a medical education, so they can judge the essence of diseases and the principles of dealing with them only at the philistine level.

The relationship between a nurse and a doctor

And deontology calls for a respectful attitude of staff towards each other. Otherwise, the team will not be able to work harmoniously. The main link of professional relations in the hospital is the interaction of doctors with nurses.

First of all, nurses need to learn to observe subordination. Even if the doctor is very young, and the nurse has worked for more than 10 years, she should still treat him like a senior, fulfilling all his instructions. These are the fundamental foundations of medical ethics and deontology.

Especially strictly such rules in relationships with doctors, nurses should be followed in the presence of the patient. He must see that the appointments are made by a respected person who is a kind of leader capable of managing the team. In this case, his confidence in the doctor will be especially strong.

At the same time, the foundations of ethics and deontology do not forbid a nurse, if she is experienced enough, to hint to a novice doctor that, for example, his predecessor acted in a particular situation in a certain way. Such advice, expressed in an informal and polite manner, will not be perceived by a young doctor as an insult or underestimation of his professional capabilities. Ultimately, he will be grateful for the timely hint.

The relationship of nurses with junior staff

The ethics and deontology of a nurse requires her to respectfully treat junior hospital staff. At the same time, there should be no familiarity in their relationship. Otherwise, it will decompose the team from the inside, because sooner or later the nurse may begin to make claims about certain instructions from the nurse.

In the event of a conflict situation, the doctor can help in resolving it. Medical ethics and deontology do not prohibit this. However, middle and junior staff should try to load the doctor with such problems as rarely as possible, because resolving conflicts between employees is not part of his direct job responsibilities. In addition, he will have to give preference in favor of one or another employee, and this can cause the latter to have claims against the doctor himself.

The nurse must unquestioningly comply with all adequate orders of the nurse. In the end, the decision to carry out certain manipulations is made not by herself, but by the doctor.

Interaction between nurses

As with all other hospital workers, nurses should behave with restraint and professionalism in their interactions with each other. The ethics and deontology of a nurse requires her to always look neat and be polite with colleagues. Arising disputes between employees can be resolved by the head nurse of the department or hospital.

At the same time, each nurse must fulfill exactly her duties. Facts hazing should not be. This is especially true for senior nurses. If you overstrain a young specialist with additional job responsibilities, for the performance of which he will also receive nothing, then he is unlikely to remain in such a job for a long time.

Relationships between doctors

Medical ethics and deontology are the most complex concepts. This is due to the variety of possible contacts between doctors of both the same and different profiles.

Doctors should treat each other with respect and understanding. Otherwise, they risk ruining not only relationships, but also their reputation. Medical ethics and deontology strongly discourage doctors from discussing their colleagues with anyone, even if they are not doing the right thing. This is especially true in cases where the doctor communicates with a patient who is observed by another doctor on an ongoing basis. The fact is that it can forever destroy the trusting relationship between the patient and the doctor. Discussing another doctor in front of a patient, even if some medical error has been made, is a dead end approach. This, of course, can increase the status of one doctor in the eyes of the patient, but it will significantly reduce the confidence in him on the part of his own colleagues. The fact is that sooner or later the doctor will find out that he was discussed. Naturally, he will not treat his colleague after that in the same way as before.

It is very important for a doctor to support his colleague, even if he made a medical mistake. This is exactly what professional deontology and ethics prescribe to do. Even the most highly qualified specialists are not immune from mistakes. Moreover, a doctor who sees a patient for the first time does not always fully understand why his colleague acted in this or that situation in this way and not otherwise.

The doctor must also support his young colleagues. It would seem that in order to start working as a full-fledged doctor, a person must unlearn for many years. During this time, he really receives a lot of theoretical and practical knowledge, but even this is not enough for the successful treatment of a particular patient. This is due to the fact that the situation in the workplace is very different from what is taught in medical universities, so even a good young doctor who paid great attention to his training will not be ready for contact with a more or less difficult patient.

Ethics and deontology of the doctor require him to support his young colleague. At the same time, talking about why this knowledge was not obtained during training is meaningless. This can confuse the young doctor, he will no longer seek help, preferring to take risks, but not seek help from the person who condemned him. The best option would be to just tell you what to do. In a few months of practical work, the knowledge that was obtained at the university will be supplemented by experience and the young doctor will be able to cope with almost any patient.

Relationship between administration and healthcare workers

The ethics and deontology of medical personnel are also relevant within the framework of such interaction. The fact is that the representatives of the administration are doctors, even if they do not take a special part in the treatment of the patient. All the same, they must adhere to strict rules in communicating with their subordinates. If the administration does not quickly take decisions on those situations where the basic principles of medical ethics and deontology have been violated, then it may lose valuable employees or simply make their attitude to their duties formal.

The relationship between the administration and its subordinates must be trusting. It is really unprofitable for the hospital management when their employee makes a mistake, therefore, if the head doctor and the head of the medical unit are in their places, they will always try to protect their employee, both from a moral point of view and from a legal point of view.

General principles of ethics and deontology

In addition to private moments in the relationship between different categories, one way or another related to medical activities, there are also general ones that are relevant for everyone.

First of all, a doctor must be educated. The deontology and ethics of medical personnel in general, not only the doctor, prescribes in no case to harm the patient. Naturally, everyone has knowledge gaps, but the doctor needs to try to eliminate them as quickly as possible, because the health of other people depends on it.

The rules of ethics and deontology also apply to the appearance of medical personnel. Otherwise, the patient is unlikely to have sufficient respect for such a doctor. This can lead to non-compliance with the doctor's recommendations, which will aggravate the patient's condition. At the same time, the cleanliness of the dressing gown is prescribed not only in the streamlined formulations of ethics and deontology, but also in medical and sanitary standards.

Modern conditions also require compliance with corporate ethics. If it is not guided by it, then the profession of a medical worker, which today is already experiencing a crisis of confidence on the part of patients, will become even less respected.

What happens if the rules of ethics and deontology are violated?

In the event that a medical worker has done something not very significant, albeit contrary to the foundations of ethics and deontology, then his maximum punishment may be deprecation and a conversation with the head physician. There are also more serious incidents. We are talking about those situations when a physician commits really out of the ordinary, capable of harming not only his personal reputation, but also the prestige of the entire medical institution. In this case, a commission on ethics and deontology is assembled. Almost the entire administration of the medical institution should be included in it. If the commission meets at the request of another medical worker, then he must also be present.

This event is somewhat reminiscent of a trial. Based on the results of its conduct, the commission issues a particular verdict. He can both justify the accused employee and bring him a lot of trouble, up to and including dismissal from his position. However, this measure is used only in the most exceptional situations.

Why are ethics, as well as deontology, not always respected?

First of all, this circumstance is connected with the banal syndrome of professional burnout, which is so characteristic of doctors. It can occur in workers of any specialty, whose duties include constant communication with people, but it is in doctors that this condition proceeds most quickly and reaches its maximum severity. This is due to the fact that in addition to constant communication with many people, doctors are constantly in a state of tension, because a person’s life often depends on their decisions.

In addition, medical education is received by people who are not always suitable for work in this case, we are not talking about the amount of necessary knowledge. Here, with people, the desire to do it is no less important. Any good doctor should care at least to some extent about his work, as well as the fate of his patients. Without this, no deontology and ethics will be observed.

Often, it is not the physician himself who is to blame for non-compliance with ethics or deontology, although the blame will fall on him. The fact is that the behavior of many patients is really defiant and it is impossible not to react to it.

On ethics and deontology in pharmaceuticals

Doctors also work in this area and very, very much depends on their activities. It should not be surprising that there are also pharmaceutical ethics and deontology. First of all, they consist in the fact that pharmacists produce sufficiently high-quality drugs, as well as sell them at relatively affordable prices.

It is by no means permissible for a pharmacist to mass-produce a drug (even in his opinion, simply excellent) without serious clinical trials. The fact is that any drug can cause a huge number of side effects, the harmful effects of which in the aggregate exceed the beneficial ones.

How to improve compliance with ethics and deontology?

No matter how it sounds, however, a lot depends on money issues. It has been noticed that in countries where doctors and other medical workers have a fairly high salary, the problem of ethics and deontology is not so acute. This is largely due to the slow development (in comparison with domestic doctors) of the syndrome of professional burnout, since for the most part foreign specialists do not have to think much about money, because their wages are at a fairly high level.

It is also very important that the administration of the medical institution monitors compliance with the norms of ethics and deontology. Naturally, she herself will have to adhere to them. Otherwise, there will be a lot of facts of violation of the rules of ethics and deontology on the part of employees. In addition, in no case should one employee be required to do something that is not fully demanded of another.

The most important moment in maintaining a commitment to the basics of ethics and deontology in the team is a periodic reminder to medical personnel of the existence of such rules. At the same time, special trainings can be held, during which employees will have to work together to solve certain situational tasks. It is better if such seminars are held not spontaneously, but under the guidance of an experienced psychologist who knows the specifics of the work of medical institutions.

Myths of ethics and deontology

The main misconception associated with these concepts is the so-called Hippocratic Oath. This is due to the fact that in disputes with doctors, most people remember her. At the same time, they indicate that you need to be more compassionate towards the patient.

Indeed, the Hippocratic oath has a certain relation to medical ethics and deontology. But those who have read its text will immediately note that almost nothing is said about patients there. The main focus of the Hippocratic Oath is the doctor's promise to his teachers that he will treat them and their relatives for free. Nothing is said about those patients who did not participate in his training in any way. Moreover, today the Hippocratic oath is not taken in all countries. In the same Soviet Union, it was replaced by a completely different one.

Another point concerning ethics and deontology in the medical environment is the fact that patients themselves must follow certain rules. They need to be courteous to medical staff at all levels.

1. Deontological issues of social work

2. Basic deontological principles

Deontological issues of social work

The concept of professional duty includes the functional duties of a social worker, as well as his duty and responsibility to the people on whom his activities are ultimately directed, to colleagues, the profession, to society and the state.

The functional duties and responsibilities of a social worker are determined by the specifics of social work, which is manifested in its essence:

- social work is, in its content, a humane, highly moral type of social activity, a vivid and holistic manifestation of the humanistic orientation of society;

- professional social work, carried out on the basis of official authority, is one of the most important mechanisms for the implementation of the constitutional rights of citizens;

- social work is integrative in nature, since in the process of activity a large number of various mutually influencing and interpenetrating factors, interests, circumstances are reflected and interact, each of which must be taken into account in the theory and practice of social work;

- the main goal of social work is to achieve the maximum well-being of the individual and society in a given specific historical situation, create conditions for their harmonious development, humanization of relations between the individual and society; conjugation of their interests;

- a social worker not only can, but must use the entire range of means and methods of influence at his disposal, developed by social science and approved by society and the state - from organizational, legal and economic to psychological and pedagogical;

– social work should have the most purposeful, predictable and manageable content;

- a social worker has considerable independence in solving standard and non-standard practical problems, therefore his professional activity is individualized, and he bears individual responsibility for the final result of the activity;

- the objects of the social worker's activity are the client, the client's living environment and the connections and relationships that arise in this system; the activities of a social worker should include an active impact both on a person, a direct client of a social service, and on the environment in which his life activity takes place - his immediate social environment and relations with them, material and living conditions, economic conditions and other elements;

- the social worker gets access to complete, sometimes carefully hidden even from relatives, information about the client; obtaining, using, verifying the reliability of such information, maintaining confidentiality impose increased moral obligations on the social worker, etc.

Social work is a specific type of professional activity. This is determined by its influence on society, the special subject of labor, the content and nature of the activities of specialists, the ways and methods of influencing a person, the type of relationship that arises in the course of activities between its participants, as well as the special level of responsibility of each specialist and the entire institution of social work for the fate of clients. social services and the whole community.

In this regard, social work requires a special, additional to the legal, more stringent regulation of actions, relationships, behavior of a specialist. Such a special system for regulating the actions and behavior of a specialist in the process of fulfilling his professional duties can only be a professional ethical system, an integral part of which is deontology.

Based on the definition of the deontology of social work, the following key deontological issues of social work can be distinguished:

– professional duties of a social worker;

– the responsibility of a social worker (the labor collective of a social protection institution) to society and the state;

– the responsibility of a social worker (the labor collective of a social protection institution) to colleagues and to the client of the social service and his relatives;

– the responsibility of a social worker (the labor collective of an institution of social protection) to social work as a profession and a social institution;

– the responsibility of the social worker (the labor collective of the social protection institution) to himself.

Thus, the deontology of social work can be considered by what subjects and objects are considered as parties to a particular professional relationship. In this case, the five above-mentioned types of such relationships can be distinguished.

Medical deontology(gr. deon- due, logos- doctrine) - the doctrine of what is due in medicine, first of all, about professional duty, duties and norms of behavior of medical workers.

Along with the moral norms governing medical activity in general, special norms and standards are fixed in medical deontology in relation to a particular area of ​​medical practice (deontology in surgery, obstetrics and gynecology, pediatrics, etc.)

Deontology prescribes to the medical worker:

Fulfill your professional duty to patients and society - all your knowledge and skills should be directed to strengthening and preserving the health and life of patients;

Be conscientious in the performance of your professional duties – provide medical care, treat patients with respect and humanely, constantly improve the level of their professional knowledge;

Strive to implement the principles and norms of the medical profession in their practice - do no harm, show compassion, be fair, keep medical confidentiality.

Deontology also implies the right of medical workers to protect their professional honor and dignity.

Modern medical deontology defines:

Moral aspects of doctor-patient relationships and their specifics in pediatrics, oncology, psychiatry, obstetrics and gynecology, etc.;

Moral aspects of the relationship between the doctor and the patient's relatives;

Moral aspects of relationships in the medical team (between colleagues, a doctor and an average, junior medical staff);

Moral aspects of medical errors and iatrogenics;

Patient's rights and their normative regulation.

Medical errors in the activities of a medical worker

One of the ethical norms of medical activity is the doctor's recognition of his professional mistakes and misconceptions (they are present in the activities of any doctor) and an uncompromising attitude towards them.

A medical error is commonly understood as a conscientious delusion of a doctor, which is based on the imperfection of modern science, ignorance or inability to use existing knowledge in practice. Doctor's actions caused by negligence, negligence, ignorance are not medical errors.

The main causes of medical errors include:

Objective reasons: imperfection of medical science and practice; relativity of medical knowledge; the probability of an atypical course of the disease in a particular patient, caused by the characteristics of his organism; insufficient equipment of medical institutions with diagnostic equipment, medicines, etc.

Subjective reasons: medical ignorance due to insufficient qualifications, lack of experience and the specifics of the doctor's thinking, i.e. his individual abilities to accumulate, understand, use medical knowledge; inadequate examination and examination of the patient; refusal of the advice of a colleague or council, or, on the contrary, the desire of a doctor to hide behind the authority of consultants, etc.

All medical errors can be divided into the following groups:

Ø diagnostic errors;

Ø errors in the choice of method and treatment;

Ø errors in the organization of medical care,

Ø Mistakes in maintaining medical records.

Diagnostic errors

Diagnostic errors are the most common. The formation of a clinical diagnosis is a very complex and multicomponent task, the solution of which is based, on the one hand, on the doctor's knowledge of the etiology, pathogenesis, clinical and pathomorphological manifestations of diseases and pathological processes, on the other hand, on taking into account the individual characteristics of their course in this particular patient. The most common cause of diagnostic errors are objective difficulties, and sometimes the impossibility of early diagnosis of the disease.

Many disease processes have a long course with a significant latent period and almost asymptomatic course. This applies to malignant neoplasms, chronic poisoning, etc.

Serious diagnostic difficulties also arise in the fulminant course of diseases. As mentioned, the objective causes of medical errors can be an atypical course of the disease or combined competing diseases, a serious condition of the patient with insufficient time for examination. Significantly complicates the diagnosis of alcohol intoxication of the patient, which can mask or distort the symptoms of a disease or injury.

The causes of diagnostic errors may be underestimation or overestimation of anamnestic data, patient complaints, results of laboratory and instrumental research methods. However, these reasons cannot be considered as objective, because they rest on the lack of qualifications and experience of the doctor.

Errors in the choice of method and treatment

These errors are several times less common than diagnostic ones. In some cases, they are caused by incorrect or belated diagnosis. But even with a correct and timely diagnosis, there may be errors in treatment, for example, the wrong choice of treatment method in the presence of several possible ones or the wrong choice of the method and volume of surgical intervention. It may happen that with the timely start of treatment and the correct choice of its method, errors in technique are made. This applies primarily to surgical operations.

Mistakes in the organization of medical care

The very designation of these errors indicates that their occurrence is associated with incorrect or insufficiently thought-out organization of medical care. The reason for such errors is either the insufficiently high professional level of the heads of individual health care units, or the created unfavorable conditions for the work of a particular medical institution. As a result of errors in the organization of medical and preventive care, both the provision of medical care and patients suffer, despite the fact that doctors of medical institutions, through the fault of whose leaders errors occur, can quite conscientiously fulfill their duties.

Errors in maintaining medical records

These errors can lead to incorrect conclusions in the diagnosis of diseases, to incorrect decisions of the MSEC, to insufficiently substantiated rehabilitation measures.

The analysis of all types of medical errors plays an important role both in their prevention and in improving the skills of doctors. This analysis is carried out, in particular, at clinical and anatomical conferences, which have become an obligatory and good tradition in our clinics. For the first time they were introduced into practice by a prominent pathologist I.V. Davydovsky in 1930, and since 1935 styles have been mandatory for all medical institutions.

In the appendix to the order of the USSR Ministry of Health dated April 4, 1983, number 375, the main tasks of clinical and anatomical conferences are formulated.

They are:

Ø professional development of health care facility doctors and improvement of the quality of clinical diagnostics and treatment of patients through joint discussion and analysis of clinical and sectional data.

Ø identifying the causes and sources of errors in diagnosis and treatment at all stages of medical care, as well as identifying shortcomings in the work of auxiliary services (radiological, laboratory, functional diagnostics, etc.).

DEONTOLOGY MEDICAL(Greek deon, deont due, proper + logos teaching) - a set of ethical standards for the performance of their professional duties by health workers.

Story

The design of D. m. in the form of a special teaching as part of medicine as a science and practice of treatment is due to its humanistic content. The goals of medicine organically include moral assessments, not only because they imply ethical norms of the relationship between the physician and the patient, but also because the observance of deontol. norms by physicians in itself gives a therapeutic effect.

The term "deontology" was introduced into the everyday life of ethics in the early 19th century. English utilitarian philosopher J. Bentham. However, for the creative and practical activities of physicians, philosophical and ethical motives, as well as attention to psychol, the characteristics of the physician, the patient and their relationships, have been characteristic since the birth of medicine.

The basic principles governing the moral character of a doctor have been formed and changed over the centuries depending on the political system that has developed in a given society, socio-economic and class relations, the level of culture, national, religious traditions, etc. Accordingly, the requirements for society in different historical eras to the physical, moral and intellectual qualities of a doctor, his professional skills. Already in the Indian code of laws Manu "Veda" the rules of behavior of a doctor are listed in detail, understood as ethical norms. A significant influence on the medicine of the Ancient East and on the professional and ethical ideas of its adherents was exerted by the religious and later philosophical teachings of that time. Thus, the Egyptian medical priests, making extensive use of the experience of folk medicine and achieving great success in various areas of their specialty, created an atmosphere of mysticism, superstition, and mystery around their activities.

In the ancient world, honey views, as a rule, were directly related to philosophical, ethical and social doctrines. An outstanding role in defining the main problems of medicine both as a science and as a moral activity belongs to the founder of scientific medicine Hippocrates. Hippocrates the collection (see) is devoted not only to private questions honey. practice, but also problems of a general medical nature related to the ideological, philosophical and scientific foundations of medicine, the humanistic and moral aspects of medical practice, the norms of behavior of doctors, their relationship with patients, etc. Sections of the collection “Oath” are directly related to the problems of D. m. , "Law", "About the doctor", "About favorable behavior", "About places in a person", "About ancient medicine". Here Hippocrates succeeded in formulating a series essentially deontol. norms of lasting value. In the view of Hippocrates, the doctor-sage is the ideal of a doctor: “... Everything that is sought in wisdom, all this is also in medicine, namely: contempt for money, conscientiousness, modesty, simplicity in dress, respect, judgment, determination, neatness , abundance of thoughts, knowledge of everything that is useful and necessary for life, aversion to vice, denial of superstitious fear of the gods, divine superiority. Hippocrates formulated the obligations of the doctor in relation to the patient in the famous “Oath”: “I will spend my life and my art purely and blamelessly ... In whatever house I enter, I will enter there for the benefit of the patient, being far from everything intentional, unjust and pernicious ... Whatever I see or hear about human life from what should never be disclosed, I will keep silent about it, considering such things a secret ... ".

In medieval medicine, the principles of medical ethics, as well as the theoretical foundations of medicine, were subordinated to religious and ecclesiastical philosophy and morality and, accordingly, were deprived of their own scientific and general humane content. Nevertheless, the norms of D. m were also not alien to medieval doctors.

In the Renaissance, the humane precepts of the great ancient physicians were recognized. The famous physician and chemist T. Paracelsus wrote: “The power of the doctor is in his heart, his work must be guided by God and illuminated by natural light and experience; the greatest basis of the medicine is love ... "

R. Descartes believed that only medicine can solve problems that most of all relate to the greatness and happiness of mankind.

The principle of private practice, especially in the era of capitalism and imperialism, placed between the patient and the doctor a number of insurmountable economic, social and political barriers that make it extremely difficult for the leading doctors of the modern bourgeois world to work. However, N. A. Semashko reasonably noted that "... it would be absolutely unfair and wrong to think that in foreign countries there are no doctors - genuine humanists who are well aware of their medical duty and treat patients well." These words can also be attributed to those representatives of domestic medicine who, in the most difficult conditions of pre-revolutionary Russia, created the noblest deontol. traditions adopted by Soviet health care. M. Ya. Wise taught, "... that healing does not consist in treating the disease, nor in treating the causes - healing consists in treating the patient."

Prominent public figures, humanists, and revolutionary democrats A. I. Herzen, D. I. Pisarev, N. G. Chernyshevsky, and others had a great influence on the formation of the national dialectic.

Zemstvo medicine also played a significant role in the “deontologization” of medical activity in our country. Despite all its objective shortcomings, this system, unique in the history of medicine, of providing medical assistance to the poor strata of the population has nominated many thousands of doctors and paramedics who are infinitely devoted to their work.

What is now the subject of D. m., at the end of the 19th century. called medical ethics. The content of this concept was very vague: some authors included in it questions related to the rights of a doctor (decology), class duties, class etiquette, and even medical policy.

The merit of introducing the term "medical deontology" into the practice of Soviet health care and revealing its content belongs to H. N. Petrov. His main work on this topic, “Issues of Surgical Deontology,” served as an impetus not only for the creation of a number of books, brochures, and articles about D. m., but also laid the foundation for the scientific development of the entire problem as a whole. H. N. Petrov defined D. m. as "... the doctrine of the principles of behavior of a doctor not to achieve individual well-being and honors, but to maximize the amount of social utility and to eliminate the harmful consequences of inadequate medical work." Soviet D. m. as a scientific and practical discipline is based on the data of honey considered from the standpoint of Marxist-Leninist philosophy. psychology, ethics, pedagogy. I. P. Pavlov’s teaching made a great contribution to the theoretical aspects of D. m. The works of V. M. Bekhterev, K. I. Platonov, R. A. Luria and others, as well as the further development of the teachings of I. P. Pavlov, had a great influence on the development of optimal forms of relationships between medical staff and patients, substantiated the use of various types of psychotherapy, contributed to the development of the doctrine of iatrogenics (see Iatrogenic diseases).

In the process of developing practical problems of D. m., it turned out to be expedient “... to continue their discussion in the context of individual medical specialties” (B. V. Petrovsky). A number of works devoted to deontol have been published. problems in obstetrics, gynecology, surgery, venereology, ophthalmology, oncology, traumatology, psychiatry, phthisiology, radiology and other fields, medicine.

An important event in the popularization of the principles of D. m among honey. the public was the convocation in 1969 of the First All-Union Conference on the problems of D. m.

The Soviet doctor is the bearer of communist morality, a patriot of the socialist motherland, a fighter on the ideological front. Selfless work for the benefit of society is its sacred duty. The activity of the Soviet doctor is not limited to the treatment of patients. He is an active participant in the measures taken in our country to improve the well-being of workers, ensure the safety of their work, normalize living conditions, maximize the improvement of the environment, and extensive disease prevention. The interests of the case, the interests of patients are above all for him. Accordingly, the principles of communist morality, embodied in the Program of the CPSU, become guiding in the professional activity of a doctor, in shaping his moral character.

Elements of medical deontology

The doctor has a leading role in the implementation of deontol. principles. This refers to the behavior of the doctor, his ability to receive, the thoroughness and completeness of the examination, the persuasiveness of the conclusion. A cultural doctor is a person of a high ethical level, sensitive, attentive and caring, sympathetic and affectionate, friendly and calm. Only a doctor who has chosen his profession by vocation can build his activities in accordance with the requirements of D. m. The doctor is called upon to help a sick person, relieve him of suffering, restore his ability to work, and save him from death. To love your profession means to love a person, to strive to help him, to rejoice in his recovery. Therefore deontol. The requirement for the doctor is his constant improvement of his skills.

The concept of "doctor's skill" cannot be reduced to the sum of technical methods. Mastery represents the creative process, which is expressed in that form of intellectual work, which the doctor calls a wedge, thinking. The need to identify and analyze a lot of disparate information, choose from them essential for building a logically sound diagnostic scheme, taking into account the individual characteristics of the patient, the history and conditions of his life, in the shortest possible time to develop a plan to treat on this basis. tactics - all this most complex intellectual work forms the creative basis of medical activity. The wedge, thinking assumes the analysis and generalization of specific data, knowledge of a symptomatology, features a wedge, the course of diseases, indications of laboratory and instrumental methods of research.

The medical profession is unthinkable without constant replenishment of knowledge. The doctor should be familiar with the latest achievements of honey. sciences, with new methods of researches, with new to lay down. drugs. Improving qualifications, attention to new scientific achievements, the desire to keep up with science are mandatory for a doctor. All actions of the doctor regarding recognition and treatment must be strictly thought out and scientifically substantiated.

doctor and patient

Responsibility for the patient and his health is the main feature of the doctor's moral duty.

The skill of the doctor is a creative process, the art of skillfully combining a highly developed wedge, thinking with a sensitive attitude towards the patient, with a high personal culture of the doctor. Wedge, the thinking of a doctor is the ability not only to quickly summarize and evaluate the available data from laboratory, instrumental and other types of objective research, but also to establish personal contact with the patient. For successful treatment, the doctor must be able to get a complete picture not only of the disease in general and its specific manifestations in each case, but also of the characteristics of the patient's personality. The tactics of the doctor, his behavior should always be built depending on the nature of the patient, the level of his culture, the severity of the disease.

Each patient requires an individual approach and individual measures of influence. For some people, gentle and gentle treatment and especially convincing arguments are required to make them believe in the possibility of a cure, for others, two or three authoritatively spoken words, the severity and categorical conclusion are enough. That is why the wedge, medicine must be an art, and the doctor (clinician) must have a highly developed sense of tact, which creates harmony between him and his patient, based on kindness and respect for the dignity of each other.

The doctor has to meet with dozens of patients, different in their cultural level and mental characteristics, including those suffering from excessive suspiciousness. Therefore, one must have patience in order to listen to the patient and then methodically examine him.

In all cases, patients need consolation. However, the doctor should not try to belittle the severity of the disease. His task is to convince the patient of the real possibility of a cure. The very fact of visiting a doctor should alleviate the patient's condition. Trust in a doctor is one of the guarantees of successful treatment. In the process of communicating with the patient, the doctor must always be careful not to undermine the patient's confidence in himself with a careless word.

A doctor working in a hospital must closely monitor not only the dynamics of the disease, but also the mood of the patient, his morale. Hard and long work on creating a favorable treatment environment can be disrupted by some event, for example, the death of another patient. And again, the doctor will have to work hard to restore the proper situation in the ward and the mood of each patient. When a cure or prolongation of life is possible, the doctor must tactfully and skillfully open the diagnosis to the patient in order to create the best conditions for treatment. An exception is made for patients with malignant tumors, the Crimea is reported any other diagnosis, for example, "stomach ulcer" instead of "stomach cancer". The question of whether the patient should tell the truth arises with all its severity when the patient refuses the operation or is in an extremely serious condition. In surgical practice, situations often arise when both the patient and his relatives have to be informed about the true situation and an urgent operation is offered, for example, for gangrenous appendicitis, perforated gastric ulcer or intestinal obstruction. In such cases, the relatives of the patient are explained that being late even for a few hours threatens with death. This problem is difficultly solved when operation is offered to the patient, at to-rogo the cancer diagnosis is established. The motives for refusal are the same for the majority: they feel good and have hopes for drug treatment. Patients mistakenly believe that they will never be late with the operation.

The practice of work convinces that in cases when it is necessary to convince a patient with a malignant tumor to believe in the necessity of an operation, there is no need to report the true diagnosis. You should strive to find other sufficiently strong words and arguments. In a leisurely and sincere conversation, in a presentation of the achievements of modern medicine that is accessible to the patient, in assurance that the best specialists will treat him, as a rule, it is possible to obtain the consent of the patient. It is necessary to develop a single tactic for doctors of all specialties: if in an oncol, an institution, a patient is offered an operation, then other doctors, to which the patient addresses, should explain and convince him of the need and urgency of it.

In cases when irreversible patol, changes are available, the patient should not tell the truth. Even when the patient cannot be saved, hope must not be taken away from him. And in the last stage of the disease, a person continues to believe in salvation. He seeks not truth, but hope. The patient in any case should not feel doomed. The doctor must patiently listen to complaints, prescribe medicines and comfort - thoughtfully and professionally. The doctor is obliged in each case to decide the question of "what" to say to the patient and "how" to say. The doctor's conversation with the patient is an art.

It is impossible for a doctor on a round not to answer any, even the most trifling, question. The answer should sound believable and convincing. With the accumulation of experience in the mind of the doctor, the most successful and appealing to the patient formulations, logically justified answers and explanations, the most convincing words and phrases are deposited. D. m. requires that the attending physician, in the process of observation, maintain the moral state of the patient by any appropriate remark or emphasizing the positive significance of even the most insignificant shift in the state of health. At the same time, the doctor's careless word, his indifferent or irresponsible attitude towards the patient may turn out to be etiol, a factor in iatrogenic disease.

The doctor and relatives of the patient

The question of the relationship between the doctor and the patient's relatives is one of the least developed and most difficult sections of D. m. If the patient has noticed changes for the better in the course of treatment, the relationship between the doctor and relatives is always the best and most friendly. They sometimes worsen if the patient's condition worsens. If relatives go to the doctor about the patient, the fate of which inspires fear, the conversation is frank, and the doctor, as a rule, has no reason to hide the seriousness of the situation from them. At the same time, the doctor's task is to exert a psychological influence on relatives when the intervention of the latter can adversely affect the patient's condition.

When a patient is diagnosed with cancer and he gets into oncol. institution, the doctor reports the true diagnosis only to the closest relatives, and the rest are sent to an informed person.

If, with an unfavorable outcome of treatment, the rules of D. m. were followed, the relatives of the deceased even become the defenders of the doctor. If these rules are not observed, conflicts between relatives and the doctor also arise with proper treatment.

Elements of deontology in the activities of middle and junior medical personnel. In creation of an optimum situation in to lay down. institution, high service and professional discipline nurses help the doctor. High culture and neatness, cordiality and caring, tact and attentiveness, self-control and disinterestedness, humanity are the main qualities necessary for a nurse. A nurse should be proficient in the art of words, in communicating with patients and their relatives, observe a sense of proportion and tact, make every effort to create an atmosphere of trust between the patient and the doctor.

The sister should not inform either the patient or his relatives about everything related to the actual disease and the nature of the treatment, to observe medical secrecy.

In creating deontol. conditions in the inpatient department, the nurse plays an important role. The cleanliness of the wards, fresh air, comfortable bedding, exemplary patient care - this is the minimum of hospital comfort, which is created by the hands of first of all nurses. A neat appearance, smartness, polite and helpful treatment of patients are the requirements that D. m makes to the nurse. The work of caring for the seriously ill is particularly difficult. The nurse should wash them several times a day, change bed and underwear, feed, water. Only a person of great courage, with a sympathetic soul, can perform such work. “The training of nurses and nurses, their upbringing and the formation of masters of their craft from them, instilling in them the principles of a psychotherapeutic, careful and gentle approach to the patient is a task of paramount importance” (B.V. Petrovsky).

The relationship of medical workers

An important problem of D. m. is the neutralization of some of the negative aspects of the differentiation of medicine into specialties. The doctor, of course, cannot be equally well versed in all sections of honey. activities, therefore, timely consultations with doctors of another specialty are necessary. If errors are found by doctors who have previously observed the patient, then in the presence of the patient it is absolutely unacceptable to discuss these errors. They should be corrected in a businesslike manner, with great tact and, of course, not at the bedside of the patient. Doctor-to-physician conversations should always be based on mutual respect and mutual assistance. It should be considered unacceptable to criticize the consultant in the address of the attending physician in the presence of the patient or holding a consultation in the absence of the attending physician. From the standpoint of D. m., such a statement of the case is correct, when not the patient is consulted, but the doctor.

Relationships between doctors, nurses and paramedics must be impeccable and based on absolute mutual trust. It is not permissible to address the sisters with “you” and make comments to them in the presence of the patient. In eyes of patients it reduces authority to lay down. institutions. Unfriendliness and arrogance of the leader, cringing and obsequiousness of subordinates exclude the possibility of correcting mistakes and progress in work.

Deontology and organization of work of a medical institution

In to lay down. such an environment should be created in the institution, which would spare the psyche of patients as much as possible and give rise to an atmosphere of trust in the doctor. This can be achieved by proper organization of labor, high culture of employees and clear labor and professional discipline. Already the first meeting at the reception desk of the polyclinic or the emergency room of the hospital should create an atmosphere of positive mood for the patient. Both the registrar and the sisters of the polyclinic should be interested in the mood of the patients, do everything possible to reduce the waiting time for an appointment. The whole atmosphere of the doctor's office should contribute to creative work and dispose to a calm, intimate story of the patient. An immutable rule should be established: during the reception and examination of the patient, any interference that distracts the doctor is unacceptable.

It is necessary to provide everything so that the patient does not have a reason for dissatisfaction during his stay in the hospital. A beautiful interior, comfortable furniture and art reproductions on the wall, neatness of the wards, fresh air, good sound insulation, the ability to communicate with relatives and friends and use the telephone, TV - all this contributes to the treatment. Timely carrying out of researches, to lay down. procedures, strict regulation of bypass hours, ensuring silence during afternoon and night sleep - these are the conditions that are positively assessed by patients and contribute to recovery.

Everything that negatively affects the course of the disease must be eliminated: patients should not be awakened early in the morning to clean the wards, whispers and an atmosphere of oppressive silence, which do not calm, but alert the patient, must be rejected. In their free time from detours, television, radio, playing dominoes, chess, reading newspapers and magazines have a beneficial effect on patients. In good weather, patients should be allowed to walk in the fresh air. All conditions surrounding patients in to lay down. institution should encourage optimism and promote the recovery of patients.

Deontology and scientific and technical progress

Modern development of honey. technology, laboratory and instrumental methods of research leads to the replacement of direct contacts "doctor - patient" with the relationship "doctor - device - patient". There is a fear that the doctor, trusting technology, ceases to improve his knowledge, that technization can affect the relationship between the doctor and the patient and lead to a violation of the optimal psychol, contact between them. Therefore the high culture of the doctor, a combination of the developed wedge, thinking and modern scientific knowledge acquire the underlined deontol. meaning. The device should not obscure the identity of the patient. The decisive role in the diagnosis should belong to a well-collected anamnesis and a correctly performed physical examination.

Deontology in clinical medicine

The fundamental difference between surgery and all other specialties is the need for surgical intervention, a cut, even flawlessly performed, causes the patient physical. and mental trauma. The inevitable element of risk associated with surgery makes the surgeon's job stressful. The surgeon must take into account the temperament and mood of the patient in order to avoid a standard and pattern in his behavior.

N.N. Pirogov names four conditions for the correct behavior of a surgeon: the first is confidence in recognizing the disease and the patient; the second is to undertake the operation in time, producing a favorable moral influence on the patient, raising his hopes, eliminating his fears and doubts; third - not only to perform the operation skillfully, but also to be able to prevent complications; fourth - to carry out subsequent postoperative treatment with appropriate care, which is sometimes more important than the operation performed. It is the duty of the surgeon long before the operation to begin to prepare the patient for the correct behavior in the operating room. It is necessary to overcome the patient's two feelings: fear and pain. The surgical patient always experiences fear, manifestations to-rogo are sometimes hidden deep under various masks - indifference, bravado, etc. To remove fear at the patient, to-romu operation is necessary. In addition to the use of medications, a warm human word is an essential therapeutic tool. Conversation with the patient can surpass the most powerful sedative drugs in effectiveness.

Equally close attention should be paid to pain relief in minor surgery. Violation of the norms of D. m. is the refusal of anesthesia during outpatient operations and studies of painful foci. It is bad when the cry of the patient is suppressed by the cry of the surgeon.

The danger of the operation should not exceed the danger of the disease itself. In difficult situations, when the only means of salvation is an operation, deontol remains unshakable. principle: the surgeon decides the issue in the interests of the patient, pushing into the background secondary considerations and concerns about his own reputation.

The “optimist” doctor presents the patient with any operation as trifling, and the “pessimist”, on the contrary, emphasizes the danger of the operation. It is necessary to be guided by the following: the more severe and dangerous the disease, the greater the deviation from the truth is permissible and even obligatory for the doctor informing the patient; the easier the disease and the better the prognosis, the less reason to hide the truth.

Informing a woman in a form accessible to her about the essence of the disease, obstetricians and gynecologists should, in an optimistic tone, inspire her with faith in a successful outcome of childbirth or illness. The doctor should not report the diagnosis until he is sure of it: if the diagnosis is not confirmed, the mental trauma inflicted on the woman leaves a trace for a long time.

Many gynecological surgeries are associated with subsequent violation of menstrual and reproductive functions. Therefore, it is necessary to seriously address the issue of indications for surgery and methods of surgical intervention, taking into account not only the immediate results, but also long-term consequences.

Although the head of the department makes the sole decision on the appointment of an operating surgeon, it is necessary to take into account the desire of the patient. If, for the benefit of the patient, the operation should be performed by the leading surgeon, he must invite the chosen patient doctor as an assistant. A report on the radical removal of the uterus or appendages should be made before discharge from the hospital. In case of impossibility of childbearing due to congenital or acquired changes in the genital area, the patient must be informed about this. From positions D. of m production of small ginekol, operations without anesthesia should be considered inadmissible.

The most important law of obstetric and gynecological departments is such education of personnel, when only the attending physician or the head of the department provides information about the treatment and prognosis. The attending physician finds himself in an extremely difficult situation when the patient's husband asks about the nature of the operation performed. The rule should be followed: do not inform the husband of the specific volume of the operation performed. It is better when the patient herself tells her husband what kind of operation she has undergone, choosing for this the most convenient option for her.

A sick child needs a special approach from a doctor. In their relationship, emotional influence plays a leading role. In a pediatrician, in addition to purely medical experience and knowledge, pedagogical, and, consequently, knowledge of child psychology should also be added. The pediatrician must learn to establish good contact with children. The atmosphere in the children's institution should be friendly, consistent with the behavior and views of children. During examination, treatment, and especially in preparation for surgery, the doctor should strive not to deceive children, not to tempt them with unfulfillable promises. It is necessary that each member of the team shape their behavior with a small patient according to the type of relationship between mother and child. The warm warmth of people in white coats helps the child to get back on his feet.

The doctor should spare no time to explain to relatives about the child's health and possible prognosis. When talking, you need to avoid both elements of excessive optimism and intimidation. Those families where the child is the only one, where there will be no more children, require special attention.

Among the population there is a widespread opinion that malignant tumors are incurable. That is why the very direction to the oncol, the institution is perceived by the patient and his relatives so hard and tragic. D. m. obliges the oncologist from the first minutes of communication with a cancer patient to make him believe in the possibility of a cure. It is necessary that the doctor and other health workers in a conversation with the patient do not use the word "cancer" and that the patient does not read this word in any of the documents given to him in his hands. It is better to replace the word "cancer" with the words "organic disease" or others that do not alarm and injure the patient.

The task of D. m is to ensure that patients with initial forms of cancer entering the hospital for radical treatment do not meet with patients who have cancer of the same localization, but who come again with metastases, relapses, etc. From deontol . considerations, patients who need only symptomatic treatment should be hospitalized in general hospitals and treated in the same way as all patients in serious condition are treated.

Contradictory to D. m. the assignment of patients with generalized forms of cancer to "uncurable", that is, not subject to treatment. The use of radiation and chemotherapeutic means of exposure makes it possible to obtain a certain regression of the process, to achieve an improvement in the general condition, remission. Patients sometimes return to work. This improvement is a great personal merit of the doctor, his deontol. education and direction. Incurability does not mean incurability, and helping cancer patients in the most difficult stage of the disease for them is one of the main deontol. principles.

In contradiction with deontol. rules enter those doctors who allow themselves to predict terms of life onkol, patients. Doctors are obliged to take all possible measures to prolong life, but not to predict the day of death. Such "prophecies" are inherently immoral. The above fully applies to cases of not always justified use of complex diagnostic and therapeutic manipulations associated with a risk for the patient and a high degree of responsibility for the doctor (electric shock, angiography, endoscopic research methods, liver biopsy, kidneys, etc.).

Deontology and medical documentation

In all cases, the patient's awareness of a serious illness exacerbates existing symptoms, reduces the effectiveness of radical or palliative treatment. It is necessary that the name of a serious illness is not mentioned in the documents issued to the patient. The established practice of issuing copies of analyzes to patients on forms is contrary to the rules of D. m, in which the normal indicators of any study are indicated in typographic font and the indicators of the study of the patient himself are written next to it. The difference in indicators always injures the patient, who sees in each discrepancy a threat to health and confirmation of his suspicion of a serious illness.

Do not count with deontol. rules those radiologists who issue to patients on hands rentgenol, descriptions of the investigated body. The structure and function of even a normal organ in the recording looks sometimes ominous for an ignorant patient. With deontol. positions it is necessary to refuse delivery to patients on hands of descriptions rentgenol, pictures. Certainly, rentgenol, the diagnosis should spare mentality of the patient extremely.

Medical secrecy

In the capitalist countries the doctor, receiving the fee for rendering to lay down. assistance, is sometimes forced to hide certain facts about the patient, even to the detriment of others. In socialist countries, a doctor is obliged to keep secrecy as long as it does not affect the interests of society. Article 16 of the Fundamentals of the Legislation of the USSR and the Union Republics on Healthcare states: “Doctors and other medical workers are not entitled to disclose information about the disease, intimate and family aspects of the patient’s life that have become known to them due to the performance of their professional duties.” The doctor and paramedical staff who have the opportunity to get acquainted with honey. documentation, must keep secret not only the information reported to the patient, but also the very fact of the disease transferred by the patient. You cannot mention the names of the patient in scientific papers and reports, as well as show a photograph of the patient without masking his face.

However the doctor is obliged to immediately inform a dignity. authorities about cases of acute infectious diseases and poisoning, investigating authorities - about murders and severe injuries, one of the future spouses about the illness of the other. The doctor is also obliged to inform the heads of institutions about the illness of people whose work is contraindicated in this industry, for example, about epilepsy in a car driver, about certain diseases and bacillus carriers of a person working in a food company or in a children's institution.

medical errors

The object of the doctor's influence is a person.

This is the profound difference between the medical profession and all other professions. No one, except a doctor, has to delve so deeply into a person's life with its complex mental and moral world, experiences. That tension, in which the doctor's activity constantly proceeds, and those imperfections of honey. sciences, with which it is impossible not to be considered, create an objective possibility of medical errors. These mistakes are all the more explicable if one takes into account the complex and difficult work of a doctor, especially a surgeon, and the need to urgently take rational, effective measures, sometimes under the most unfavorable conditions. Every doctor, no matter how much knowledge and experience he has, is not guaranteed against mistakes. The possibility of medical errors (see) is explained by the fact that "the doctor has to deal not with standard material that can be easily assessed and taken into account, but with all sorts of individualized features of the human body" (IV Davydovsky).

Medical errors, including those that lead to death, are always made public in the health care system. Such errors are discussed at medical conferences, at congresses, at meetings of scientific about-va doctors, are shined in periodic honey. press and lectures in honey. in-tah. Monographs are devoted to medical errors. Finally, the governing bodies of the ministries of health issue orders that analyze the most serious and typical medical errors, the reasons that gave rise to them, and provide suggestions and instructions for preventing their recurrence.

At the same time, coverage of medical errors in the general press sharply contradicts the foundations of D. m. This newspaper material is read also by patients in-tsakh. Each patient and his relatives are alert, they begin to critically “think about” the treatment prescribed for him, and thereby undermine the efforts of the doctor in the fight against the disease. Among the factors that ensure the best results of treatment, the authority of the doctor, his dignity and morale are of decisive importance. This section of D. m. requires development.

Deontol contradicts. principles of accessibility to the population of popular literature on serious diseases. Propaganda of data on preventive maintenance of diseases, about bases a dignity is more necessary. culture, about rational nutrition, about the dangers of smoking and alcohol, about the significance and benefits of preventive examinations. This literature should not be designed for physicians, but specifically for replenishing the minimum of honey. information from the general population*.

Deontology in research work

The requirements of D. m. acquire special significance in research work. The doctor-researcher's deontology is part of the general D. m. The research work includes testing and approbation of vaccines for scientific purposes, honey. drugs and dosage forms, diagnostic equipment, new methods of operations, endoscopic and laboratory research methods.

In Art. 34 of the Fundamentals of the Legislation of the USSR and the Union Republics on Health Care states: “In the interests of curing a patient and with his consent, and in relation to patients under 16 years of age and mentally ill, with the consent of their parents, guardians or trustees, a doctor may apply new, scientifically substantiated, but not yet approved for general use, methods of diagnosis, prevention, treatment and medicines. The procedure for the use of these methods of diagnosis, prevention, treatment and medicines is established by the Ministry of Health of the USSR. New honey. those which are not included in the current State Pharmacopoeia of the USSR and were not applied in a wedge, practice are considered drugs.

The primary use of new drugs and vaccines in humans is very responsible. With deontol. positions, it is necessary, after a comprehensive check on healthy and sick animals, to entrust the testing of a new drug in the clinic to qualified doctors with experience in research work.

It should be guided solely by the interests of the patient when establishing indications for complex and dangerous instrumental studies, for example, for puncture liver biopsy, laparoscopy with preliminary pneumoperitoneum, the introduction of drugs and contrast fluids into the cavity. D. m obliges to use all the listed manipulations only when it is unconditionally shown to this patient, and to subordinate to this principle the tasks of identifying scientific factors or applying technical innovations.

Experimental research on prisoners, mentally and seriously ill patients, as well as on children, is not allowed, regardless of parental consent. The use of painful and not entirely safe instrumental studies for scientific purposes is possible only with the consent of the person being studied and his awareness of the degree of risk.

Any new operation requires a very thorough theoretical and experimental development, after which it can be allowed for use only in well-equipped clinics and hospitals.

Need to develop deontol. rules on homotransplantation of organs and tissues. These issues are regulated by the instructions M3 of the USSR, according to the Crimea, it is allowed to take cadaveric material for honey. institutions involved in the preparation and preservation of tissues for transplantation.

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A. F. Bilibin, E. A. Vagner, S. B. Korzh.