The importance of medical ethics and communication in the current healthcare context

Introduction

Work is, par excellence, a means of obtaining the income necessary for existence, an opportunity to put into practice the knowledge acquired during the years of study, a form of recognition, of doing good, of manifesting creativity and learning, a continuous relationship, both horizontally and vertically, which requires a sustained effort to reveal aspects of the human dimension through knowledge of organizational behavior from the perspective of professional satisfaction^(1,2).

Organizational behavior is the systematic study of the behavior of individuals within groups, including the analysis of the nature of groups, the development of structures within and between groups, and the process of implementing change. Individual or organizational behavior is considered to be directed towards a goal. Every human action has a primary motivation, and most actions are attempts to maximize satisfaction by fulfilling multiple needs. In order to demonstrate the influence of professional satisfaction, but also its importance, the renowned psychologist and philosopher Abraham Maslow created and developed a theory of the personality of the human being, as a whole, which had a special influence in several fields, an influence that was due, in large part, to the high practical level of his theory. According to his theory, human beings have five sets of needs ordered hierarchically, namely: basic biological (physiological) needs, which satisfy the needs for sleep, breathing, water, food, warmth, shelter, movement and sex; security, protection (home, in case of danger); social needs, belonging to a group (communication, involvement in solving social problems, social communion, participation in community life and social events), and the need for love and affection in a couple and from those close to them; needs for individualization, self-respect and self-esteem, the need to be listened to and understood, approval and recognition of merits, skills and value from others, success, prestige, appreciation; the need for self-actualization, to reach one’s maximum potential, to create, develop and improve.

Within the medical team, professional satisfaction and motivation are essential for optimal therapeutic performance. Professional ethics and medical communication directly influence the quality of the medical act and the patient’s level of trust in the care team. Effective communication between members of the medical team not only improves collaboration and reduces errors, but also contributes to a positive organizational climate.

Treatment adherence and modern approaches in personalized medicine

Adherence to treatment is a crucial factor in therapeutic success, significantly influencing the course of the disease and the patient’s quality of life. According to the World Health Organization (WHO), non-adherence to treatment is one of the main causes of therapeutic failure, leading to increased morbidity and mortality in chronic diseases⁽³⁾.

The factors that influence adherence to treatment are multiple and include psychological, social and economic aspects. An essential aspect in promoting adherence is the effective communication between the doctor and the patient. Patients who understand the importance of treatment and its benefits are more likely to comply with medical recommendations⁽⁴⁾.

Personalized medicine is a modern approach that can increase adherence to treatment by adapting therapies to the individual characteristics of each patient.

In addition to technological aspects, another effective method of increasing adherence to treatment is patient education. Information campaigns and psychological counseling play an essential role in motivating patients to comply with treatment.

But the answers are not so simple once we discover the medical reality. This is where norms of morality, legality and law come into play that must be explained to the patient at his level, because in Romania and beyond, a common problem is represented by functional illiteracy and the lack of integration of information in context. Another aspect that raises many difficulties is the relationship between normative and descriptive or – better said – the difference between values/norms and facts, an aspect long debated in moral philosophy that also has its impact on the medical field⁽⁵⁾.

Ethical reasoning and ethical study
of medical problems

Over time, countless problems have had their say in the medical field, and certain burdens are still felt today. A conclusive example in this regard is the COVID-19 pandemic which altered both human-to-human and doctor-patient communication, as this was difficult to achieve through masks and overalls in the hospital setting. Communication errors were present at every step, as doctors, nurses and orderlies wore hair protections that covered their ears, the masks representing a barrier against the virus and against effective communication.

Also, during the pandemic, a new ethical issue has emerged: how do we allocate limited medical resources efficiently and fairly?⁽⁶⁾ The priority of patients in the medical field has always created dissatisfaction and dissension in society. Even today, many debate this topic based on material resources, almost completely forgetting about human resources. Thus, a group of experts issued a series of recommendations from the perspective of medical ethics, among which we highlight the advice: (1) maximizing the number of lives saved and the number of years of life. Doctors should prioritize patients who have the highest chance of survival and who have, according to a reasonable estimate, the most years to live in case of survival. The advice (2) considers that medical personnel should be prioritized in the allocation of limited medical resources. The main reason for this recommendation is the fact that their activity is essential in maximizing the number of lives saved overall^(7,8).

Burnout in the context of work-life balance

According to ICD-11, burnout is a syndrome conceptualized as a result of chronic stress at work that has not been successfully managed⁽⁹⁾.

Burnout in the healthcare system as well as problems related to treatment adherence represent major challenges for modern healthcare systems. Burnout, combined with work-life imbalance, can increase irritability, making the doctor become less involved, and decrease effective communication, which can lead to an erosion of trust in the doctor, followed by a decrease in patient adherence to treatment and ultimately impacting the therapeutic outcomes, that become suboptimal, thus leading to a decrease in patient satisfaction^(9,10).

Burnout in the medical system and its effects on medical practice

Health systems that do not provide adequate support to physicians (both emotional and organizational) can increase their stress, leading to professional burnout and, implicitly, to poor medical practice by increasing the rate of medical errors and decreasing empathy in the doctor-patient relationship. Also, the lack of material resources and of necessary infrastructure increases the level of frustration among medical personnel⁽¹⁰⁾.

To prevent burnout among medical personnel, a complex approach is needed, that includes psychological support strategies, optimizing the work schedule and promoting a positive organizational climate. Interventions based on mindfulness, cognitive-behavioral therapy and resilience training have proven to be effective in reducing burnout symptoms and in increasing professional satisfaction⁽¹¹⁾.

The psychological burden of medical professionals

Certain ethical decisions, even in accordance with protocols or recommendations created by experts in communication and medical ethics, can have negative consequences on the mental health of medical personnel. The most telling example in this regard can be found in the ICU (Intensive Care Unit) departments and also refers to the pandemic period when countless doctors had to make decisions in light of limited medical resources such as ventilators in the departments, and thus decide between patients with a favorable and unfavorable prognosis, a defining criterion being life expectancy, comorbidities and complications with which patients arrived at the hospital⁽¹²⁾.

Compliance with ethical norms and recommendations at that time entailed a psychological burden whose price was paid by medical personnel both during the pandemic period, but especially in the post-pandemic period, where this chronic psychological fatigue combined with physical fatigue often led to states of helplessness, guilt, and despair. However, for their mental health, it is essential that doctors can be partially freed from the responsibility of making these decisions. This can be achieved by creating clear and precisely delimited triage criteria that guide doctors’ choices⁽¹³⁾.

In the coming years, we will also see the impact of the long-COVID syndrome on infected medical personnel, but above all, we will be able to comment and debate how ethical issues have affected the psycho-socio-emotional health of these individuals. However, studies spanning 5-10 years are necessary to correctly highlight the impact on medical personnel.

The previously corroborated aspects also entail other problems that can be resolved through the lens of ethics and medical communication.

Addressing public justification issues through ethics and medical communication

Medical communication usually refers to the doctor-patient relationship, but it is often forgotten that this is not limited to the medical environment but can be extended, being used also in doctor-family communication, in palliative care, but especially in special conditions it is used to solve the problem of public justification. From an ethical point of view, it is acceptable to be indifferent to one’s own person, especially when it comes to situations involving life and death, but the state, through its authorities, must ensure that certain ethical principles are respected, such as the equity and efficiency of the medical system, and to ensure effective communication with the entire population, so that it can accept the justification of allocative policies⁽¹⁴⁾.

Discussion and conclusions

Although ethics and medical communication may seem like secondary concerns in medicine, this article highlights their fundamental role in modern healthcare. These elements, while not directly part of scientific treatment, are essential pillars that support the mental well-being of healthcare workers and ensure high levels of patient treatment adherence. Without them, the healthcare system would struggle to function effectively.

The approaches of different countries or hospitals are different, but they must always be based on important ethical and moral principles which should be oriented towards treatment, while not forgetting the medical team and its psycho-emotional health.    

Corresponding author: Eduard-Cristian Enache E-mail: enache.eduard-cristian@stud19

Conflict of interest: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY licence.