Culture of Medicine

Prof. dr. Mohammad Hakimi, SpOG(K), PhD.

 Background
As medical students proceed through the
clinical rotation at medical school, they meet
tremendous challenges to their professional
development
The "culture of medicine" on the wards and in
the clinics takes its toll on our students
 Background
Most students survive these threats to their
well being and become acculturated to the
world of medicine, albeit, often with residual
feelings of anger, resentment and hostility
Others go on to perpetuate the same practices
on those trainees more junior
 Background
In an effort to make the experience of clinical
rotation more humane, and allow for
discussion and reflection, new policies and
educational programs will be developed at
UGM
 Culture
(Merriam-Websters Collegiate Dictionary)

a. The integrated pattern of human

knowledge, belief, and behavior that
depends upon man's capacity for learning
and transmitting knowledge to
succeeding generations
 Culture
(Merriam-Websters Collegiate Dictionary)

b. The customary beliefs, social forms, and

material traits of a racial, religious, or
social group
 Culture
(Merriam-Websters Collegiate Dictionary)

c. The set of shared attitudes, values, goals,

and practices that characterizes a
company or corporation
Adjusting to the Culture of Medicine

In addition to acquiring a great deal of

knowledge, your years in medical school
are an intense process in acculturation
The culture of medicine has its own
norms, rules and expectations
Adjusting to the Culture of Medicine

Much of this culture is imparted through the

hidden curriculum: what students learn by
observation of role models
Often this new behavior is incorporated without
thinking
Self-reflection and discussion with others can
help you to consciously process the hidden
curriculum so that you have a choice about the
behaviors you adopt
Adjusting to the Culture of Medicine

There are four categories of

acculturation:
1. Integration occurs when a student maintains
an active interest in both the culture of
origin and the new culture (medicine)
2. In assimilation, a student concentrates on
the new culture but has no interest in the
native culture
Adjusting to the Culture of Medicine

There are four categories of

acculturation:
3. Separation occurs when a student focuses
on the culture of origin while being
uninterested in the new culture
4. Finally, marginalization represents the
attitude of a student with no interest in
maintaining or acquiring proficiency in
either culture, native or new
 Adjusting to the Culture of Medicine
Take a moment to think about where you are
in the midst of your acculturation journey and
how it affects your well-being
For first-year students, the lack of elder
students to guide you through the new
curriculum may wear on your resilience
 Paternalism
(Merriam-Websters Collegiate Dictionary)

1. A system under which an authority

undertakes to supply needs or regulate
conduct of those under its control in matters
affecting them as individuals as well as in
their relations to authority and to each other
2. A policy or practice based on or
characteristic of paternalism
 Culture of Medicine
and Medical Error
The culture of medicinewith its emphasis on
professional autonomy, collegiality, and self-
regulationis unlikely to foster the reporting of
mistakes
Moreover, the organisational culture of the NHS,
with its emphasis on blame, and an increasingly
litigious public may only serve to exacerbate the
problem
(Lawton and Parker, 2002)
 Culture of Medicine
and Doctor-Patient Relationships
Medicine is expert centred
Medical culture tends to maintain patients'
dependence and childlike compliance by means of
power and control, labelling, and treating, which
often distance the patient from the expert
Medical culture often maintains mystique by using
jargon and withholding information
(Menage, 1997)
 Culture of Medicine
and Preventive Services
Clinical preventive services, such as screening tests,
immunizations, and behavioral change counseling,
should be a key component of the shift away from a
reactive, disease-oriented medical culture toward a
proactive, health-based one
But many of these services, studies show, are being
honored more in the breach than in the observance
(Reynolds, 1998)
 Culture of Medicine
and Medical Education
Deficiencies in education about end-of-life
care are widely recognized, both in the
formal or structured curriculum, and in the
informal curriculum (the culture in which
students are immersed as they learn
medicine)
(Block, 2002)
Another cultures of medicine

Evidence-based medicine
American
Doctor
Patient
Disease-oriented
Others
 Resolution of the clinical scenario
An ethical dilemma. Medical errors and
medical culture. BMJ 2001;322:1236-40.
1236.pdf
 Whistleblower

There are many reasons why doctors remain silent

in similar situations, though two in particular have
impeded openness in the past:
Firstly, the culture of medicine has been one in which
you shouldn't let the side down, and in which
whistleblowing is seen as sneaking on your colleagues
Secondly, confidentiality clauses in NHS trust contracts
effectively gagged employees
But the culture and the law are changing