Mutual learning to overcome

the risk of self-referencing

in health professions.



Antonio Del Puente, Antonella Esposito,
Vinicio Lombardi
1
, Aldo Bova
2
, Raffaele Scarpa.

Rheumatology, University Federico II;
1
P.O. San Giovanni Bosco;
2
P.O. San Gennaro.
Naples, Italy.
The practice of medicine in the modern
era is beset with unprecedented
challenges in virtually all cultures and
societies, like the temptation for
physicians/health professionals to
forsake their traditional commitment to
the primacy of patients interests.
The Lancet 2002, 359:520-22
Ann Int Med 2002, 136:243-246
Many physicians/health professionals wind
up having no desire to do more than the
minimum required.
This cultural shift risks destroying some
essential aspects of the medical profession
that contribute to high-quality health care,
including pride in profession, sense of duty,
altruism, and collegiality.
Extending oneself to patients, families,
trainees, and colleagues not only is a
traditional element of medicine but translates
into more effective care.
NEJM 2009, 360:101-3
Dissatisfation
WHO 2003: for each chronic disease the simple
compliance would have better effects than any
recent therapeutic progress
Transplant rejection: 1 out of 4 is caused by no
compliance
Myocardial infarction relapse, hypertension,
diabetes, hypercholesterolemia are caused in 1
patient out of 2 by no compliance.
Grimaldi A, Lyon-Caen O: Le dbat, 167:18;2011
Altruism, extending oneself to patients (what
we would like for ourselves in case we were
patients)
A professional and fraternal approach to the
patient is a problem that touches the technical
questions.
It has to do with the correct application of the
method of our profession.
It is part of the professional debate.
To face the question of the deterioration
of the relationship between health
professionals and patients will
strengthen the efficiency of the medical
profession.
UNESCO Chair in Bioethics at the
International Center of Health, Law
and Ethics, University of Haifa
Aim of the project was to check whether the
lack of proper study of ethics in medical
schools was one of the reasons for the
phenomenon of deterioration of the
relationship between doctors and patients.
UNESCO Chair in Bioethics at the
International Center of Health, Law
and Ethics, University of Haifa
Importance and quality of education in
ethics in medical colleges and faculties.

Performed in 110 medical institutes all over
the world.

The subject of ethics was found to be taught
in 105 (95%) of these institutions.
UNESCO Chair in Bioethics at the
International Center of Health, Law
and Ethics, University of Haifa
The ethics courses are compulsory in 88% of the
medical institutions studied.

Number of hours allotted to the teaching of ethics:

up to 10 hrs= 9% of the institutions;
10 to 20 hrs= 29%;
20 to 50 hrs= 33%;
50 to 100 hrs= 7%;
Over 100 hrs= 8%.

One should logically deduct that the problems stems
not so much from the quantity as from the quality of
the tuition.
UNESCO Chair in Bioethics at the
International Center of Health, Law
and Ethics, University of Haifa

The UNESCO Chair of Bioethics has launched
an initiative to form a new curriculum of
medical ethics which is critical in this
scenario.

Starting from our teaching experience we
would like to outline an aspect of current
culture (self-referencing) which jeopardizes
this and similar efforts and to suggest a
supportive approach.
The technical-scientific culture claims to be the
only approach which can generate reasonable
conclusions (self-referencing).


This self-limitation of the reason confines to
subjectivity all the considerations on the complex
unity of the human being and its absolute value,
which are absolutely reasonable, although not
demonstrable by experiment. Reasonable and
binding.
Del Puente A, et al.: J Med Pers 2010

Main consequence of self-referencing is the
mechanistic reduction of our profession that
confines the medical action to a neutral
technique which is ineffective and against
the spirit of the experimental method.

It is at the root of the deterioration of the
relationships.
Del Puente A, Esposito A: Il contributo della
esperienza cristiana alla professionalit medica,2002

In this context a generic reference to
professional values may remain ambiguous
and ends up reinforcing this attitude of self-
referencing.


Values without reference fall prey of those
who have the strength every time to
redefine their content, preventing any real
confrontation, debate and mutual learning.

How can we overcome this self-referencing
attitude?

Reasonably recognizing that what is true in
our human experience is not irrelevant to
our work.

Del Puente A, Esposito A, Lombardi V, et al: Recenti Prog Med 2013
We need to open the door to the cultural and
educational relations that express the full
extent of our human experience and can
actually sustain our demanding profession.

Proper laicity is not indifference, but can be
the engine of the new curriculum initiative or
of any similar initiative aimed at facing the
question of deterioration of the professional
relationships.
Del Puente A, Esposito A, Lombardi V, et al: Recenti Prog Med 2013

Laicity is acknowledgement of full right of
citizenship in the professional debate for positions
that openly express their motivation, fully open to
mutual communication and learning.
This does not limit anyones freedom, rather it
represents the willingness to put at everyones
disposal all available energy.

Not indifference or self-referencing, but opening
the doors to educational relationships, to the
resources of the entire human life.
Del Puente A, Esposito A, Lombardi V, et al: Recenti Prog Med 2013
As an example, at medical school of the Federico II
University and in the CME programs for health professionals
of two Hospitals, we perform the optional course The
contribution of Christian experience to health professions.

The program is structured in 5 to 8 lessons and is followed
by dedicated periodical educational workshops. It includes
encounters with effective professional experiences that do
not deny the relevance of full personal human experience
and its impact on the technical action.

By discussing about the concept of health and on the
everyday problems of our profession, the course outlines
that Christian experience is not an idea but an
educational relationship which makes reasonable what we
seek: a professional/fraternal approach.

This is an example that wishes to stimulate similar and
plural contributions.

No self-referencing / deterioration of the relationships.



1) Rediscover the educational relationships which may
sustain the professional/fraternal approach in our work,
necessary condition for its efficacy.

2) Study their interaction with technical questions.

3) Mutual learning: share our work.
Thanks for your attention


delpuent@unina.it
Our experience indicates the need to favor positive
interaction among professionals, aimed at
expressing judgments and initiatives on issues
dealing with our profession, having as starting
point all resources of the human experience.

The confrontation that stems from such aperture
should be made methodical, to give energies to the
work aimed at facing the present time challenges.