Health Care Communication & Professional Ethics

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Albert Bandura’s social learning theory suggests that people learn through observation, after which they imitate or model the behavior and attitudes that they witness. Essentially, for learning to occur, the learner must pay attention, retain what they observe, and have the ability to reproduce it (Latham & Heslin 2003). However, most importantly, they should be motivated to copy the action and unless they have a good reason for doing so, Bandura claims their learning will not necessarily translate into behavioral change. In many cases, the social learning model is applied to young children, under the assumption that at birth, their minds are like blank slates, therefore, everything they come to know is a result of observation (Beth 2009). However, this model can also be applied to adult learning as the acquisition of new behavior is often influenced by the actions of the people one observes and emulates.

In the case study, it is evident that, although the doctor might be professionally competent, his arrogant attitude and failure to employ a patient-centered approach results in his providing poor quality service. Despite being repeatedly told that Anna was not drunk, he refuses to believe this, let alone listen and discharges a critically ill patient. In such a case, the doctor should be encouraged to observe other doctors and attend seminars on the sensitivity so that he can understand and emulate doctors who are more tolerant and willing to assume the patient’s point of view. However, one should not assume that he has never interacted with, or observed doctors who are more receptive to patient communication than he is. There is a chance that he has observed and learned their behavior, but he does not feel motivated enough to practice it. Given the importance of motivation in the social learning theory, it may also be necessary to try to understand if the doctor is happy with his working conditions because his lack of motivation could be a reflection of dissatisfaction or personal problems.

However, even from a non-medical viewpoint, it is evident that the doctor was extremely subjective and irrespective of what he thought of the woman, he should at least have listened to what her husband said. Another element of social learning is evident in his dismissing her because he had seen too many drunks wasting hospital time. If this was true, then it is possible he had previously witnessed cases where fellow doctors dealt with pseudo-emergencies arising from drunk “patients” and he was reproducing the skills he had acquired through social learning. Should this be the case, then it is important that sensitivity and communication training be offered to all the doctors at the hospital to reduce scenarios like the one described.

Another model that can be used in analyzing the case study is Shannon’s communication theory in which he claims that communication is a process entailing four key elements (Matveev & Savkin 2007). There is the information, the transmitter, and the channel through which the transmission occurs, on the other hand, there is the receiver who decodes it. However as it is transmitted, the message can be distorted by any one of various types of noises making it difficult for the receiver to decode it (Lombardi 2005). In verbal communication, these noises may include semantic, cultural environmental, and psychological noises, because of which communication breakdowns may ensue. In the case study, the main source of noise is psychological since the doctor’s attitude makes it difficult for him to “hear” what Paul and his wife are trying to communicate to him.

According to Shannon’s theory, noise is the operational word used to connote both the traditional notions of distractive sounds and other factors that interfere with the delivery of a message. Semantic noise, for example, occurs when two parties cannot communicate effectively because of language barriers. In the case study, the noise in question is mostly psychological as evinced in the doctor’s apparent unwillingness to listen with an open mind. However, this might also have been a two way process since the patient’s husband was already frustrated by the poor services they had received from the hospital’s staff. To a minor extent, there could also be a degree of physiological noise, which is characterized by the patient’s inability to articulate her problem, therefore, making it possible for the doctor’s subjective assessment to go unchallenged. If she could have spoken, she might have enabled him to recognize her problem and possibly avert what turned out to be an erroneous diagnosis.

His blind insistence that she is drunk results in his inability to understand her problems and, as a result, he fails to diagnose and possibly provide assistance that could have de-escalated her stroke. A possible solution for improving the doctor’s attitude would be to have him reflect on what his patients and their families say before he forms his opinions. To this end, he should be made to attend communication classes, where he can be familiarised with listening skills such as, empathetic listening, otherwise, he will continue to harass his patients and ignore their needs, which may eventually have fatal consequences.

References

Beth, R,N, 2009, ‘Role modeling excellence in clinical nursing practice’, Nurse Education in Practice, vol. 9, no. 1, pp. 36-44.

Latham, G, P & Heslin, P. A, 2003, ‘Training the trainee as well as the trainer: Lessons to be learned from clinical psychology’,Canadian Psychology, vol. 44, no. 3, pp. 218-231.

Lombardi, O, 2005, ‘Dretske, Shannon’s Theory and the Interpretation of Information’, Synthese, vol. 144, no. 1, pp. 23-39.

Matveev, A, S & Savkin, A.V., 2007, ‘An Analogue of Shannon Information Theory for Detection and Stabilization via Noisy Discrete Communication Channels’. SIAM Journal on Control and Optimization, vol. 46, no. 4, pp. 1323-45.

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