BEHAVIOURAL SCIENCE

Professionalism in Health Care

A good doctor–patient relationship depends on professionalism.
Professionalism is built on three things:

Knowledge + Skills + Attitude

A doctor must care for both:

 Soma = Body
 Psyche = Mind

Knowledge (What a doctor should know)

Knowledge is the understanding of facts, concepts, and information gained through
learning and study.

Simple words:
What you know.

Example (doctor):
Knowing symptoms of diabetes, causes of hypertension, principles of communication

A professional doctor should:

1. Differentiate normal from abnormal (medical, psychological, social).

2. Understand the link between biological, psychological, and social factors in disease
(biopsychosocial model).
3. Use behavioural science principles in history taking, assessment, and treatment.
4. Ask not only for lab tests and X-rays but also about social life, stress, emotions, and
family background.
5. Use both:
o Medicines (pharmacological treatment)
o Counselling, lifestyle advice (non-pharmacological treatment)
6. Apply evidence-based medicine (use research findings in practice).

B. Skills (What a doctor should be able to do)

Skill is the ability to apply knowledge effectively to perform a task.

Simple words:
What you can do.
Example (doctor):
Taking patient history, examining a patient, giving counselling, writing notes.

✍️Written Communication Skills

A doctor should be able to:

 Write properly in medical language

 Take and write a complete patient history
 Maintain clear medical records
 Write management plans, discharge notes, and referrals

Verbal Communication Skills

A doctor should:

 Build good relationships with patients and attendants

 Use polite and appropriate language
 Communicate clearly with patients, families, nurses, doctors, and public
 Give good presentations
 Educate and counsel patients
 Use effective communication in every interaction

🏥 Patient Management Skills

A doctor should be able to:

 Understand history and examination → reach diagnosis

 Identify patient problems and manage them properly
 Prioritize which problem needs attention first
 Use evidence-based medicines and counselling
 Provide counselling independently

📚 Research Skills

A doctor should:

 Search medical literature (books, journals, guidelines)

 Understand research articles and use correct information
 Participate in teaching, training, and research activities

C. Attitudes (How a doctor should behave)

Attitude is the way a person thinks, feels, and behaves towards others and situations.
Observable behavior.
Simple words:
How you behave.

Example (doctor):
Showing empathy, being honest, being respectful to patients.

Towards Patients

A professional doctor should:

 Build ethical and therapeutic relationships

 Follow the biopsychosocial approach
 Show empathy, kindness, and understanding
 Put patient’s benefit above personal interest
 Follow medical ethics
 Show honesty, compassion, respect
 Work well in a team and also lead when needed

Towards Self-Development

A doctor should:

 Respect all humans regardless of religion, race, or status

 Be non-judgmental and non-discriminatory
 Be honest and fair
 Adapt to changing situations
 Keep learning throughout life
 Recognize stress in self and others
 Handle criticism positively
 Take second opinions when needed
 Be a good team member and leader

Towards Society

A doctor should:

 Be sensitive to social, ethical, and legal issues

 Provide cost-effective treatment

Additional Signs of Professional Behaviour

👔 Professional Dress

 Dress neatly, decently, and professionally

 Appearance should make patients feel comfortable
⏰ Punctuality

 Be on time for duties, rounds, lectures

 Shows discipline and seriousness

📋 Knowledge about Patients

 Know details of your patients

 Be prepared to present patient history
 Shows dedication and responsibility

✅ Conscientiousness (Responsibility)

 Take responsibility for patient care

 Shows sincerity towards profession

🧾 Honesty in Reporting

 Always report patient findings truthfully

 Admit mistakes
 Maintain confidentiality
 Dishonesty is considered serious misconduct

📞 Availability

 Be available for patients

 Inform patients if unavailable and arrange alternative care

🤝 Relationships

 Maintain respectful relationships with:

o Patients
o Nurses
o Doctors
o Students
o Teachers
 Poor relationships may indicate unprofessional behavior

Knowledge = Know | Skill = Do | Attitude = Be

✅ Part A: Correct Answers with Explanations

1. Expensive gift from patient
Correct answer: e) Politely refuse to take the gift and explain that it is against medical
ethics.
Why: Accepting expensive gifts can create conflict of interest and boundary violation.
Professional boundaries must be maintained.

2. Emergency unconscious patient (RTA, shock)

Correct answer: c) Start life-saving measures immediately

Why: In emergencies, implied consent applies. Saving life comes first.

3. Diabetic patient refuses to stop sugary drinks

Correct answer: d) Non-compliance

Why: Patient understands advice but does not follow it.

 Resistance = unconscious psychological opposition

 Non-compliance = conscious refusal to follow treatment

4. Patient refuses dialysis

Correct answer: c) Explain pros and cons and leave the decision to her
Why: This respects patient autonomy and supports informed decision-making.

5. HIV-positive patient – disclosure

Correct answer: e)

Counsel the patient, encourage him to tell his wife, and inform him that if he refuses, you may
have a duty to inform her.

Why:
Balances:

 Confidentiality
 Beneficence
 Non-maleficence (protecting spouse)

This is the most ethically sound approach.

✅ Section B: Short Essay Answers

1. Essential Principles of Medical Ethics

The four core principles:

 1. Autonomy – Respect patient's right to make decisions
2. Beneficence – Act in patient's best interest
3. Non-maleficence – Do no harm
4. Justice – Fair distribution of healthcare

Two most commonly ignored ethical norms:

 Autonomy (doctors often make decisions without proper consent)

 Confidentiality (patient information shared casually)

Other commonly violated:

 Inadequate informed consent

 Poor communication
 Lack of respect

2. Difference between Transference and Counter-transference

Feature Transference Counter-transference

Who experiences
Patient Doctor
it?
Toward whom? Toward doctor Toward patient
Patient projects past feelings onto Doctor projects own emotions onto
What happens?
doctor patient
Doctor feels overprotective toward
Example Patient sees doctor as father figure
patient

✅ Extra Exam-Style MCQs (Very Important for Exams)

1. A patient refuses blood transfusion due to religious beliefs. Doctor should:

a) Force transfusion
b) Inform police
c) Respect patient's decision
d) Ask family to force consent
Answer: c

2. Which principle is violated if doctor shares patient details without consent?

a) Justice
b) Autonomy
c) Confidentiality
d) Beneficence
Answer: c
3. Treating a poor patient before a rich one with same condition relates to:

a) Autonomy
b) Justice
c) Beneficence
d) Veracity
Answer: b

4. Consent taken after procedure is:

a) Valid consent
b) Implied consent
c) Informed consent
d) Invalid consent
Answer: d

5. A doctor develops romantic feelings for patient. This is:

a) Transference
b) Counter-transference
c) Resistance
d) Projection
Answer: b

6. A patient calls the doctor “just like my mother”. This is:

a) Counter-transference
b) Transference
c) Compliance
d) Regression
Answer: b

7. Which consent is used in emergency?

a) Written consent
b) Proxy consent
c) Implied consent
d) Verbal consent
Answer: c

8. Breaking bad news should be done:

a) In front of other patients

b) Quickly and coldly
c) With empathy and privacy
d) Only by nurse
Answer: c

1. Consent
➤ Valid Consent

Definition: Consent that is given voluntarily, by a competent person, after adequate information
is provided, and before the procedure.

Requirements of valid consent:

 Competent patient
 Voluntary (no pressure)
 Informed (risks, benefits, alternatives explained)
 Given before procedure

➤ Informed Consent

Definition: A type of valid consent where the patient fully understands:

 Nature of procedure
 Risks and benefits
 Alternatives
 Consequences of refusal

➤ Invalid Consent

Definition: Consent that is not legally or ethically acceptable.

Examples:

 Given by a child or unconscious patient

 Taken under pressure or threat
 Taken after the procedure
 Without proper information

➤ Implied Consent

Consent assumed in emergency when patient is unconscious and life-saving treatment is

required.

2. Autonomy
Definition: The right of the patient to make decisions about their own body and treatment.
Example: A patient refusing dialysis despite medical advice.

3. Confidentiality
Definition: The duty of a doctor to keep patient information private.

May be broken when:

 Risk to others (e.g., HIV to spouse)

 Court order
 Notifiable diseases

4. Doctor–Patient Relationship
Definition: A professional relationship based on trust, respect, confidentiality, and ethical
conduct.

Doctor must maintain:

 Professional boundaries
 Respect
 Honesty

5. Medical Negligence
Definition: Failure of a doctor to provide standard care, resulting in harm to the patient.

Elements:

 Duty of care
 Breach of duty
 Damage to patient

Example: Giving wrong drug dose causing harm.

6. Therapeutic Privilege
Definition: When a doctor withholds certain information because disclosure may seriously harm
the patient.

Example: Not telling a very anxious patient immediately about terminal diagnosis.

Used rarely and carefully.

7. Empathy vs Sympathy
Empathy Sympathy
Understanding patient's feelings Feeling sorry for patient
Professional Emotional
Better for clinical practice Can reduce objectivity

8. Types of Consent (Short list for exams)

 Informed consent
 Written consent
 Verbal consent
 Implied consent
 Proxy consent (guardian)

9. Rights of Patients
Commonly asked in exams:

 Right to information
 Right to confidentiality
 Right to consent
 Right to dignity and respect
 Right to refuse treatment
 Right to privacy

10. Duties of Doctors

 Provide best possible care
 Maintain confidentiality
 Obtain proper consent
 Treat patient with respect
 Maintain professional competence
 Honest communication

11. Ethical Issues in HIV

Doctor should:

 Maintain confidentiality
 Counsel patient
 Encourage disclosure to spouse
 If patient refuses and spouse is at risk → doctor may inform spouse ethically
12. Ethical Issues in Abortion
Based on principles:

 Autonomy of mother
 Beneficence
 Legal framework of country
 Doctor must follow law and ethical guidelines

13. Euthanasia
➤ Active Euthanasia

Deliberate act to end life (illegal in most countries)

➤ Passive Euthanasia

Withholding life support (sometimes allowed ethically and legally)

14. Professional Misconduct (Examples)

 Accepting expensive gifts from patients
 Romantic relationship with patient
 Breach of confidentiality
 False medical certificates
 Negligence

15. Professionalism in Medical Practice

Includes:

 Honesty
 Respect
 Punctuality
 Responsibility
 Accountability
 Ethical behavior

One-line Definitions (Very Useful for Viva)

 Consent: Patient's permission for treatment
 Autonomy: Right to self-decision
 Confidentiality: Keeping patient information private
 Negligence: Failure to provide standard care
 Empathy: Understanding patient's feelings
 Sympathy: Feeling pity for patient
 Euthanasia: Intentional ending of life to relieve suffering