Society and Medicine: Insights from Course Experience

The universal human experience of illness and the resulting need of sick people for care, cure, and healing give medicine its essential character. These aspects distinguish medical practice from other human activities and permit its permanence. In view of this, the lessons learnt from ‘society and medicine’ course are many including the fact that medicine is not simply used to overcome biological pathologies as some people perceive it, but to actually improve human capacities. Nevertheless, it would be incomplete to exclusively explore this aspect within the conversation about the proper aims of medical practice, neglecting the purposes of society.

I’m therefore, convinced beyond doubt that medicine does not exist in isolation and it must be in dialogue with the society it serves. This means that reflecting on medicine and its aims needs to take the social frame within which medical practice comes to fruition into account.

Society and medicine course taught me how to apply behavioural sciences for effective health care; how to use of principles of behavioural sciences in communication with the patients and their families; how to integrate knowledge of behavioural science with medical science in clinical training and future practice and how to adopt a holistic approach to treatment, care and management of illness. Against this, I also noted that approximately half of all causes of morbidity and mortality in the world are linked to behavioural factors. Smoking, sexual promiscuity, diet, risk taking, and other factors under the broad heading of lifestyle may increase the chance of a person acquiring lung cancer, sexually transmitted diseases, diabetes, and other illness. Behaviour may also affect risk for acquiring infectious diseases. In addition to these adverse health effects of harmful behaviours, behavioural factors also encompass Social factors and Psychological factors.

I further learnt a number of compelling reasons why all physicians need to possess knowledge and skill in behavioural sciences. The reasons included: so as to become an effective medical practitioner and that it is important to understand individuals, family and community plus the social context one operate from and to prevent a parochial (narrow) view of medicine which confines the physician to the hospital and constrains influence on the individual or community. Other reasons were that physicians need to possess knowledge and skill in the behavioural sciences because they become better equipped to recognize patients’ risky behaviours and foster changes in those behaviours through appropriate interventions. Physicians also acquire skills in society and medicine which are essential for the prevention of many chronic diseases and for the effective management of patients with these diseases. These skills assist physicians in building therapeutic relationships with their patients and increase the likelihood that patients will follow their advice.

The course also taught me the theories of learning and how they could be used in medical practice; the processing in memory and the three memory systems; the process of forgetting, ways of improving memory and the use of the information to help devise effective ways to revise for tests and exams.

According to Leibowitz (1997) “complex thinking, communication and collaboration will be among the essential process areas for the world as we will know it”. This suggests that ability to think critically is an important trait for all members of society. With today’s multinational, multicultural, complex issues, citizens must be able to sift through large amounts of data to make intelligent decisions. Thinking critically must be a focus of higher education in order to provide the intellectual training for its students to participate in this world.

In addition, the course also made me understand motivation and emotions terms; explained the theories of motivation, relationship between motivation and health, components of emotion and relationship between emotion and health.

Furthermore, the course taught me how I could employ skills of communication to medical practice; how to discuss and display good skills of communication; how to develop language and approach that shows an appreciation of other cultural values; how to freely interact with colleagues and share information; how to handle difficult patients from different social, cultural and economic backgrounds; how to develop approaches and strategies that would be used to deal with communication challenges in various contexts.

The course also made me understand non-verbal communication, communication barriers, how to outline and analyse various barriers to effective communication and also how to demonstrate an ability to recognise, avoid or adjust to barriers in doctor-patient communication including the importance of non-verbal communication in doctor-patient relationships, how to identify non-verbal cues/signals, how to use non-verbal communication appropriately, how to write academic texts, how to use correct references, grammar an style use dictionaries and thesauruses, how to write well-structured paragraphs, how to write-structured introductions, discussions and conclusions, how to express myself in a cohesive, coherent and logical manner (signposting) and how to be aware of the dangers of plagiarism.

And according to Journal of Contemporary Medical Education, “about 80% of doctor’s work involves communication such as speaking, listening and writing. But what we hear like the tone of the voice, vocal clarity and expressiveness conveys only 40% of the message. Facial expression, posture, eye contact, touch and gesture can convey 50% of the message and words can convey only 10% of the message. So doctors have to priorities their way of communication according to the situation and person. This can be achieved only by prior training.”

Sari et al also states that effective communication between patients and physicians is fundamental for good medical practice. Patients in primary care have identified interpersonal communication skills as the most important and desirable attribute of professionalism that affects the process of healthcare.

Good communication skills have benefits for patients, doctors and the process of care. Organisation-wide relationship-centred communication skills training at the Cleveland Clinic has improved patient satisfaction scores, physician empathy and self-efficacy, and reduced physician burnout according to Boissy.

The course went as far as teaching me how develop skills of counselling for the student-doctor, how to develop characteristics of being a meaningful helper, how to develop skills of communication that forms basis of doctor-patient interaction, how to develop excellent practitioner-patient relationships and how to use the holistic approach to practicing medicine through the five star doctor. This in turn would help a physician to build strong relationships not only with patients but with family, colleagues and the community at large.

The course was interesting that it also clearly brought out the concepts of pain, grief, death and dying; the difference between grief and mourning; characteristics of grief; identified mental, physical, social, and spiritual aspects of normal grief responses; identified and highlighted techniques to use to cope with grief and loss; described the significance of using trans-cultural communication when caring for patients from diverse cultural backgrounds who are experiencing pain.

Against this background, it is suffice to state that learning about society and medicine has opened up new perspectives. The new perspectives opened in this regard include: physicians engagement in a kind of performance, in which every word, every gesture, every intonation, is carefully sculpted for the benefit of the patient. This suggests that physicians should never express anger, play favourites, inspire false hopes or unnecessary doubts. When a physician is feeling harried, exhausted, insulted, conflicted, turned on, put upon, pulled at, taken advantage of, or panicked – they must keep it to themselves because this is what patients want, and have a right to expect: Someone on their side, fighting for them, a human being, without unkind feelings, who makes no mistakes. With this in mind, physicians must continue to seek and remedy ‘defects in society’ if health is to be recognized as a basic human right.

Another perspective that could be cited in this case is the advancement in technology which has made medical information available to any member of the public who has access to a computer.

However, in a health service driven by political imperatives which insist on ever-increasing throughput, these demands cannot always be met. This mismatch between rising expectations and what can be delivered in routine practice has resulted in much dissatisfaction and increasingly intrusive policies that prescribe medical practice ever more closely, without narrowing the apparent gap between what some patients want and what they get.

It is also believed that physicians have sometimes failed to keep up with changing societal expectations. This has been highlighted by the responses to high-profile cases of poor, or even criminal, practice. There is a perception that the profession has not taken seriously enough the reform of its regulatory procedures.

Bearing in mind that medical science and society setups changes each time, and that they will keep changing in fundamental ways, what I have learnt in the course already apply in my current life because as a student physician I have already started helping out patients in my community to minimize their pain; helping them recover from diseases faster and also helping them learn to live with a disability injury if that’s the case at hand. I am also able to administer patient’s ability to enjoy life, even when they cannot be cured. This is to say, I make a huge difference to them and their families.

And I am also equal to the future illness occurrence tasks especially that I am knowledgeable that when an individual get sick, they live an existence characterized by anxiety, and this is basically due to two reasons: on one hand, they do not know the causes of that altered state of their existence and they lack the knowledge and the skills necessary to cure themselves; on the other hand, they cannot be sure they will be ‘healthy’, ‘whole’ again. In such cases, I need to employ sound judgement and cope with uncertainty. As you maybe aware, good medical practice can never consist of automated journeys down algorithms and standardised care pathways.

The course also applies in my relationship with a patient as it offers unique insight into the lives and needs of a vast cross-section of the Zambian public.

Additionally, medicine being a profession of primary care, Starfield (2000) states that in everyday life of a physician, the course applies in delivering a disproportionate share of ambulatory care to disadvantaged populations.

And Ferrer adds that since physicians are responsible for providing comprehensive and continuing care to every individual seeking medical care, irrespective of age, sex and illness. Therefore, in their lives they care for individuals in the context of their family, their community and their culture and have a professional responsibility to their community.

What I have learnt relate to the betterment of my community and the health system in Zambia because just by promoting preventive medicine and keeping the people health, physicians reduce health gaps between rich and the poor. This alludes to the fact that nobody wants to become sick, disabled or helpless. Therefore, preventing sickness or injuries in my community is a basic benefit to the population around. And rendering expertise to the community becomes less expensive to the patients and this betters their health. On the other hand, patients lose less income if they don’t get sick often.

Furthermore, owing to the fact that courses such as medicine and society course are key to the way in which the medicine profession inculcates its enduring values and acquires and retains the skills needed to adapt to an ever-changing healthcare environment lays a foundation of how the learnt lesson relate to the betterment of my community and health system in Zambia. Against this, it is suffice to state that Zambia, along with most other industrialised nations, faces a growing burden of chronic disease resulting from changing diet, lifestyle, the fact that people are living longer as a result of improved medical treatment and the effective management of formerly fatal disorders. Rates of obesity, diabetes, cardiovascular disease, chronic obstructive pulmonary disease and depression are increasing amongst the population, whilst arthritis and dementia are an increasing part of the disease burden in our aging population.

Meanwhile, British Medical Association attributes this to the system of having the focus of health care to change from one dominated by acute care to one centred on preventative and therapeutic care, emphasising ‘wellness’ and the management of chronic and long-term conditions. These illnesses require a new approach to improving the lives of sufferers and also to empowering patients to manage their own conditions, in partnership with health care professionals.

In the face of these challenges, lesson from a course such as medicine and society have continued to be responsible for, and responsive to, major advances in medicine. The rapid pace of scientific discovery and technological innovation over the past few decades is unprecedented. Medical practice is a dynamic synthesis between the application of new technologies and the enduring values of Medicine. The ability to develop new treatments and to maintain the traditional patient-doctor relationship is at the heart of the role of the clinical academic. By bridging the clinical and academic divide, the lessons obtained from the course are crucial to the successful translation of innovation into day-to-day practice and generally the health system in Zambia.