ETIQUETTE WITH PATIENTS and THEIR FAMILIES
A. Bed-side etiquette
B. Dealing with the family
C. Informed consent
E. Giving bad news
18.2.2 ETIQUETTE WITH THE DYING
A. Making the dying patient comfortable:
C. Spiritual preparation.
D. The last stages
E. Death and burial
18.2.3 THE HEALTH CARE TEAM
A. General concepts and principles of group work
B. Etiquette of teaching, learning in the health care team
C. Etiquette of care delivery in the health care team
D. The health care team: general group dynamics
E. The health care team: special group dynamics
A. Nature and essence of communication
B. Face to face communication
C. Communication in small groups
D. Use of the telephone
E. Barriers to effective communication
A. Purpose of negotiation
B. Strategy of negotiation
C. Negotiation tactics
D. Management of a negotiation session
18.2.1 ETIQUETTE WITH PATIENTS and THEIR FAMILIES
A. BED-SIDE ETIQUETTE
Obligation to visit the patient, wujuub
iyadat al mariidh: The ward rounds fulfil one of the social obligations of visiting the sick (KS 505). Visiting the sick has a lot of excellence, fadhl iyadat al mariidh,
(KS 505). Care givers get a lot of reward from Allah for fulfilling this social obligation in addition to the rewards for
their medical work The caregiver should interact with the patient as a fellow human. The human relation has priority over
the professional patient-physician relation. Some bedside visits should therefore be purely social with no medical procedures
or medical discussions.
Etiquette of visiting a patient, adab
‘iyadat al mariidh: The prophet regularly visited his companions who fell sick (KS 505, MB #1956). His behavior
at the bedside of the patient is good guidance for both the physician and the other visitors to the patient. The books of
sirah have preserved for us memories of such visits such as what the prophet said during the visit (KS 505). The following
are recommended actions during a visit to the patient: supplication, dua, for the patient (KS 505, MB #1961), reading Qur'an for the patient (KS 505), and asking
the patient for supplication, dua. The Qur'an is a cure, al Qur'an dawa (KS p. 338). Dua
is a cure, al dua dawau (KS p. 338). The Prophet gave us guidance on what can be
said and what should not be said in the presence of the patient (KS 505). The following are enjoined: asking about the patient’s
feelings, sua'al anhu, doing good/pleasing things for the patient, ihsaan, making the patient happy, tatyiib nafs al maiidh, and encouraging the patient to be patient, tashjiu al mariidh (KS 505).
The patient should be discouraged from wishing for death wishing death, tamanni al
mawt (KS 524).
Appearance of the caregiver: The caregivers must make sure that they
are clean and are dressed appropriately. The type and style of dress create impressions and convey messages. The dress, hair,
and shoes of the caregiver must convey the impression of a serious, organized and disciplined person. The use of cosmetics
should be limited to just covering up any defects and restoring the normal, average, and natural appearance. Excessive use
of cosmetics conveys the impression of egoism and lack of seriousness. Perfumes should be used in moderation to suppress any
unpleasant body odors. Excessive use, when the patient is aware that the caregiver
is wearing perfume, is discouraged.
Mannerisms of the caregiver: Caregivers must have a cheerful disposition,
imbisaat (MB #2045). They must deal with patients with leniency, rifq (MB # 2025). They must strive to do good, ma'aruf (MB #2024).
They must also have only good thoughts about their patients, husn al dhann. They must avoid evil or obscene words (MB #2026). It is important for the caregiver to have full
interaction with the patient but must still observe the rules of lowering the gaze, ghadh
al basar, except when medical necessity dictates otherwise. Caregivers must not be arrogant and show off (MB #2116). They
must adopt an attitude of humbleness, tawadhu'u (MB #2117) all the time.
Emotional involvement: It is very wrong for caregivers to adopt a detached
emotionally-neutral disposition thinking that is the way of being professional. Caregivers must be loving and empathetic,
tawadud & tarahum (MB #2018). They must show mercifulness, rahmat (MB #2020). The emotional involvement must however not go to the extreme of being so engrossed that rational
professional judgement is impaired.
Covering of awrat: Both the caregiver and patient must cover awrat as much as possible. However, the rules of covering are relaxed because of the necessity, dharurat, of medical examination and treatment. The benefit, maslahat,
of medical care takes precedence over preventing the harm inherent in uncovering awrat.
When it is necessary to uncover awrat, no more than what is absolutely necessary
should be uncovered. To avoid any doubts, patients of the opposite gender should be examined and treated in the presence of
others of the same gender. The caregivers should be sensitive to the psychological stress of patients, including children,
when their awrat is uncovered. They should seek permission from the patient before
they uncover their awrat. Caregivers who have never been patients may not realize
the depth of the embarrassment of being naked infront of others. An epileptic woman who was embarrassed at the uncovering
of her awrat during an attack came to the prophet. He prayed for her and Allah
answered the prayer (MB #1954).
Medical procedures: Caregivers must be fully aware of their legal liabilities
and responsibilities, mas'uliyat al tabiib
(Sunan Abu Daud Kitaab al diyaat baab 24, Ibn Majah Kitaab al Tibb baab 16). The rules of seeking permission, isti' dhaan, must be followed whenever caregivers approach a patient.
The patient must be forewarned about the approach of the caregiver and should not be surprised. The privacy of the patient
must be respected and he or she should be examined after getting permission. Medical care must be professional, competent,
and considerate. Medical decisions should consider the balance of benefits and risks. The general position of the Law is to
give priority to minimizing risk over maximizing benefit, dar'u al mafsadat muqaddamu
ala jalbi al maslahat. Any procedures carried out must be explained very well to the patient in advance.
Supporting care: The caregivers must listen to the felt needs and problems
of the patients. They should ask about both medical and non-medical problems. Supportive care such as nursing care, nutrition,
cleanliness, and ensuring physical comfort are as important as the medical procedures themselves. In terminal cases it is
only the supporting care that can be given.
Managing fever: Fever is a generalized often non-specific patho-physiological
response. It is a cause of much discomfort. Caregivers should detect it early and treat it effectively. The prophet described
fever as a blow of hot wind from hell-fire. He recommended using cold water to cool the body during fever (MB #1972). Any
additional methods of reducing body temperature should be used.
Managing pain: The caregiver should comfort the patient in pain. He
can explain that there is reward, ajr, for being patient when suffering (MB #1953).
The patient should persevere and not wish for death, tamanni al mawt, because of
extreme pain (MB #1958, 1959, 1960). The patient should be reassured that there is eventually a cure for every ailment, dawa li kulli dai (MB #1962) so that there is no loss of hope.
Control of infections: The prophet forbade a sick person visiting the
healthy (KS 504) to prevent spread of infection. Precautions against spread of contagion were also recommended (MB #1969).
Caregivers are obliged to make sure they have all their infectious diseases treated so that they are not a risk to their patients.
B. DEALING WITH THE FAMILY
Support: The family is also a victim when any member falls sick. The
caregiver must provide psychological support to them. Sometimes even material support may be necessary. It should be remembered
that part of the well being of the patient is to know that the family left behind is not suffering.
Reassurance: Illness is a cause of much anxiety for the family. The
caregiver must take time to reassure the family by explaining what is going and assuring them that the best care is being
given. They must be told not to give up hope because Allah in His power can reverse the most serious or critical conditions.
In communicating with the family caregivers must make sure they do not violate medical confidentiality except where it is
Involvement: Caregivers should similarly realise the importance of
visits by relatives and friends and should plan their ward routines to maximize such visits. The family can be involved in
some aspects of supportive care. This is helping them fulfil kindred obligations, silat
al rahim. It uplifts the patient's morale to see that the family care and are around being involved.
Interference: Caregivers should be on the guard to make sure that the
eagerness of the family to be of assistance and to be involved does not step beyond the limits. The family may interfere with
medical care causing disturbance of the medical routines. This should be resisted with firmness.
Conflict: Illness is a stressful condition that generates anxiety in
the family. It may initiate conflicts or aggravate existing ones. Caregivers may unwittingly find themselves in the middle
of such conflicts. They should have the clarity of mind to understand that it is none of their business solving family conflicts.
If they do they may regret it since they may become party to the conflict and are considered by some members of the family
to favor other members.
C. INFORMED CONSENT
Choice of physician: As long as patients are conscious and are in full
control of their mental faculties, they should be consulted about choice of physicians. Minors, unconscious patients, and
those who have lost legal competence can not choose physicians. Their legal representative, waliy, will have to make the decisions. The caregiver must realise that choice of a physician is a continuing
resolution and must make sure that there has been no change of mind on the part of the patient or the legal guardian. Permission
to treat must be sought at every visit though not necessarily in a formal way. It is illegal to treat a patient against their
will unless provided for otherwise by the Law in defined exceptional circumstances. As guidance to the patient in physician
selection, the following order of priority is followed: Muslim of the same gender, non-Muslim of the same gender, and Muslim
of the opposite gender.
Choice of treatment, food, and drink: The sunnah has given us guidance about forced feeding and forced treatment (KS 505: Sunan al Tirmidhi Kitaab al Tibb
Chapter 3). The patient retains freedom to accept treatment or to reject it. The patient can not be forced to take any medication
or undergoes any medical procedures. Treatment with new/experimental drugs or procedures requires informed consent. If the
patient has lost legal capacity, ahliyat, by being unconscious or by losing mental
capacity, the guardian, waliy, will take binding decisions on behalf of the patient.
Illogical refusal of treatment or food could be grounds for finding a patient intellectually and legally incompetent making
it necessary for the guardian to make the necessary decisions. Some situations of refusal of treatment are not issues of freedom
of choice but have criminal implications. For example a patient with pulmonary tuberculosis who refuses treatment is committing
the crime of endangering the lives of other members of the community. A parent who refuses immunization of a child is endangering
the health of that child and other children in the community.
The secret, al sirr: The
Qur'an mentioned the term secret in many verses (p. 570 2:77, 2:235, 2:274, 5:52, 6:3, 9:78, 10:54, 11:5, 12:19, 12:77, 13:10,
13:22, 14:30, 16:23, 16:75, 20:7, 20:62, 21:3, 25:6, 34:33, 35:29, 36:76, 43:80, 47:26, 60:1, 64:4, 66:3, 67:13, 71:9, 86:9).
The term secret is relative. What may be a secret for one person may not be for another. What may be a secret in one place
and at a particular time may no longer be a secret when time and place change. Secrets are of various degrees of importance.
Revelation of some secrets could hurt an individual. Others can hurt the whole community or the whole ummat. Some secret information could be harmful if it is related directly to one individual but could be harmless
if it is generalised.
Concept of keeping secrets, kitman
al sirr: Humans are capable of deliberately hiding and sitting on information (p. 986 3:72, 2:228, 2:271, 3:167, 4:42,
4:149, 5:61, 5:99, 6:28, 14:38, 21:110, 24:29, 27:25, 33:54, 60:1). Allah knows all what humans hide and reveal (p. 986 2:33).
The natural default situation is for humans to divulge and share information during conversations even without being obliged
or expecting any benefits. Keeping a secret therefore requires effort and discipline. Hiding information may be praiseworthy
for example if a person does not reveal is iman infront of enemies, kitman al iman (p. 986 40:28). Keeping a secret, hifdh al sirr, entrusted to you in confidence is a sign of good Islamic character ( ). You may keep your own secrets from people who are potential enemies. The Prophet
taught us to rely on keeping secrets in managing our affairs, al I'itimad ala al kitman
fi qadhai al hajat ( ).
Secrecy could be negative if it involves hiding the truth that should have been spread to others, kitman al haqq (p? 2:42, 2:146, 2:159, 2:173, 3:71, 3:187, 4:37, 5:15, 6:19). It is also negative to hide evidence,
kitman al shahadat (p. ? 2:140, 2:283, 5:106). The basic position is to keep secrets
and information and not reveal them even if there is no foreseeable harm. It is part of good Islamic character not to reveal
all what a person knows. The Prophet taught that people should listen more and speak less.
Written Records: Secrets are kept within the person, al kitman fi al nafs (p. 987 2:235, 2:284, 3:29, 3:118, 3:154, 27:74, 28:69, 33:37, 40:19). With development of
writing and electronic technology, we now have other ways of keeping secret information. The Qur'an mentioned the tools for
producing written records as paper, sahifat (p 979 20:133, 52:2-3) and the pen,
qalam (p 979 68:1, 96:4). The Qur'an used the term kitaab to refer to written records such as scriptures (p. 977 4:153, 6:7, 17:93, 21:103, 29:48, 34:44, 35:40,
37:157, 34:21, 62:5), the Qur'an ( ), the record of pre-destination, kitaab al qadr (p. 978 3;145… 57:22), the record of values, kitaab al qiyam (p. 979 98:3), the record of knowledge, kitaab al ilm
(p. 979 27:40)., and correspondence letters (P. 979 27:28-29). He process of
writing was mentioned about evidence, kitabat al shahadat (p 979 43:19) and contracts,
kitabat al uquud (p. 979 2:235, 2:282-283). Writing of false records was severely
condemned (p 979 2:79). The prophet gave guidance about writing and writers (KS p. 452). In a modern medical environment,
many records are generated about each patient. These prove a challenge as far as keeping of secrets is concerned because many
people can access them. Besides their use in medical care, the records ca be used for medical education, medical research,
and for legal purposes. Prevention of access to records for educational purposes may fall under the prohibition of hiding
knowledge, kitman al ilm.
Basis for medical confidentiality: Medical confidentiality has psychological,
social, and legal bases. The psychological basis is the private and privileged relationship of trust between the patient and
the caregiver. Revealing secrets that occurred to a third party is a violation of the trust. Such violation destroys future
co-operation because the patient will hold back some information from the caregiver thus impairing correct diagnosis and appropriate
management. The social basis lies in the prohibition of spreading rumors, namiimat
(MB #2032) and backbiting. The legal basis is three Principles of the Law, qawaid al
sharia, and the Law of Property. The Principle of Injury, dharar, states that
an individual should not harm others or be harmed by others, la dharara wa la dhirar.
The Principle of Hardship, mashaqqa, states that hardship mitigates easing of the
sharia rules and obligations, al mashaqqa
tajlibu al tayseer. Necessity legalizes the otherwise prohibited, al dharuraat
tubiihu al mahdhuuraat. Necessity is defined as what is required to preserve the five Purposes of the Law (religion, life
progeny, property, and intellect). If any of these five is at risk, permission is given to commit an otherwise legally prohibited
action. The ownership of the records is not clear. Do they belong to the patient, the caregiver that wrote them, or the institution?.
Using the law of property, a product belongs to the person who made it. In this case, the patient is the 'maker' of all the
medical facts that are written and should be the acknowledged owner of the records. The patient is also the only person involved
who has most to lose if records are misused. Thus, the contents of the medical records can not be revealed without the express
permission of the owner. The general position regarding medical records is that they are a secret that can not be revealed
without specific necessity, dharurat, as defined by the law.
Release of information by the patient: The patient should consider
any injurious information as a secret and can not reveal it. If it is about his sins or dishonorable shameful things, fahishat, he is forbidden. The prophet condemned al mujahir. A Muslim
should repent and conceal his sins (MB #2037).
Release of the information by the caregiver: It is prohibited for the
caregiver to use the privileged medical information he has for any personal gain. For example, he can not use his knowledge
of the health of a businessperson to buy shares in a certain company. He can not advise his relatives about marrying or not
marrying a certain person because of what he knows about their health. Release of information in the public interest is a
more complicated situation. The question arises whether a caregiver is obliged to reveal disease in a leader or airline pilot
that could endanger the public? What should the caregiver do if he knows of a patient with a contagious disease that is in
the community and is endangering others? Is it a violation of privacy for the caregiver to share medical information with
other caregivers caring for the same patient? What about using the data for medical research or medical education? How much
can the caregiver tell the relatives of the patient without compromising the regulation of keeping secrets? What should the
caregiver do if approached by law enforcement agencies asking for specific medical information that can help them solve a
crime? Can a caregiver testify in court against his patient using information obtained during the medical examination? All
these are questions for which no easy answers can be given most of the time. The simplest situation is when the patient, the
owner of the records, consents to their release provided no other individual is directly hurt by such a release. There are
situations in which over-riding public interest will require refusing to release information even if the patient consents.
If the patient or his guardian do not consent, the caregiver can not release information except in situations of legal necessity,
dharurat, as defined above. Education, research, and crime investigations do not
fall under the category of necessity. In cases of court litigation, The caregiver could testify in criminal cases that involve
dhulm. The Qur'an forbids the revelation of the shameful unless there is dhulm (p 308 4:148, 24:19). The caregiver can not give false testimony (MB #1176). One of the ways for the caregiver
to decrease his risk of revealing secret information is to have only the minimum needed for his work. This means that during
history taking only those questions directly related to the medical problem should be asked. There should be no probing or
digging for unrelated facts.
Testimony in court: false witness. Justice vs privacy. Revealing the shameful only if there is dhulm
E. GIVING BAD NEWS
The patient: tell half truth, do not tell at all, white lie/technical
The relatives: to convey info to patient in their own way
Officials: return to work, sick leave
18.2.2 ETIQUETTE WITH THE DYING
Narcotics are given for severe pain. Drugs are used to allay anxiety and
fears. The caregivers should maintain as much communication as possible with the dying: patience. They should attend
to needs and complaints and not give up in the supposition that the end was near. Attention should be paid to the patient's
hygiene such as cutting nails, shaving hair, dressing in clean clothes. As much as possible the dying patient should be in
a state of rutual purity, wudhu, all the time.
The dying patient should as far as is possible be helped to fulfill acts of worship especially the 5 canonical
prayers. Physical movements should be restricted to what the patient's health condition will allow. There us guidance on salat even for the unconscious patient (KS 505)
C. SPIRITUAL PREPARATION.
Death of the believer is an easy process that should not be faced with fear or apprehension. The process of death
should be easier for the believer than the non-believer (KS 525). The soul of the believer is removed gently (KS 525, 525,
525). Believers will look at death pleasantly as an opportunity to go to Allah.
They should be told that Allah looks forward to meeting those who want to meet Him (KS 525). Dying with Allah's pleasure (KS 525) is the best of death and is a culmination of a life-time of good work. Thinking
well of Allah is part of faith (KS 525) and is very necessary in the last moments when the pain and anxiety of the terminal
illness may distract the patient's thoughts away from Allah. Having hope in Allah at the moment of death (KS 525) makes the
process of dying more acceptable.
D. LEGAL PREPARATION
Helping patient make a will:
During the long period of hospitalization, the health care givers develop a close rapport with the patient. A relationship
of mutual trust can develop. It is therefore not surprising that the patient turns to the care givers in confidential matters
like drawing a will. The health carwe givers as witnesses to the will must have some elementary knowledge of the law of wills
and the conditions of a valid will, shuruut al wasiyyat. One of these conditions
is that the patient is mentally competent. The law accepts clear signs by nodding or using any other sign language as valid
expressions of the patient's wishes. The law allows bequeathing a maximum of one third of the total estate to charitable trusts,
waqf, or gifts. More than one third of the estate can be bequeathed with consent
of the inheritors. Debts must be paid before death or before the division of the estate.
E. DEATH, BURIAL, and MOURNING
The last moments: The last moments are very important. The patient
should be instructed such that the last words pronounced are the kalimat, the testament of the faith. Once death has occurred
the body is placed in such a way that it is facing the qiblat. Eyes are closed and the body is covered. Qur'an and dua are
Etiquette of morning: The
health care giver should take the initiative to inform the relatives and friends. They should be advised about the shariah
rules on mourning. Weeping and dropping tears are allowed. The following are not allowed: tearing garments, shaving the head,
slapping the cheek, wailing, and crying aloud. On receiving the news of death it suffices to say ' we are for Allah and to
Him we will return'(KS 525). Relatives are comforted by telling them hadiths of the prophet about death. These hadiths talk
about the reward of the person who loses his beloved one and he is patient (KS 524) and the excellence of one who loses three
children (KS 524).
Preparation for burial: The
health care team should practise total care by being involved and concerned about the processes of mourning, preparation for
burial and the actual burial. They should participate along with relatives as much as is possible. The body must be washed
and shrouded before burial. The washing should start with the right. The organs normally washed in wudhu are washed first
then the rest of the body is washed. Perfume can be used, Women's hair has to be undone. After washing the body is shrouded,
kafn, in 2 pieces of cloth preferably white in color.
Salat al janazat: The books of sunnat have given guidance about the
etiquette of salat al janazat (KS 162). As many persons as possible should participate in this salat. If 100 persons pray
for the dead, it is shafaa (KS 162). Dua (istighfar) in salat al janazat (KS 162).
Accompanying the funeral procession, tash'yii
an janazat: Burial should not be delayed, ta'ajil bi al janzat (KS 161). Following the procession is enjoined (KS 159). There are big rewards for accompanying
the funeral procession (KS 159). There is more reward for accompanying the funeral procession and staying until burial is
completed (KS 160). The funeral bier is carried ny men. Hurrying in marching to the grave is recommended.
Burial (dafn): face to Makka.
After burial: consoling relatives, making food for the bereaved, adab
of mourning (hidaad), condolences (ta’ziyah), inna lilaahi wa inna ilayhi rajiuun. Talking good about the dead.
Talking about the deceased: Say only good things. The good words about
the dead, thanau al nass ala al mayt (KS 160)
Special cases: Case of woman who dies with a fetus in her woumb. Opening
grave for forensic exam. Carrying the dead for burial in another country
18.2.3 THE HEALTH CARE TEAM
A. PRINCIPLES OF GROUP WORK
GROUPS: DEFINITION, CLASSIFICATION:
A group is several persons being interdependent and interacting with one another. The minimum size for a group
is three. There are no hard and fast rules about group size; it all depends on circumstances. The optimum size for a group
is 5-7 members. Larger groups do not give enough opportunity for discussion by individuals. When a group is too large, dividing
it into subgroups each specialising on a certain task may be necessary.
There are several types of groups: teams, task forces, self-directed work-teams, families, tribes, clans, fraternities,
etc. A team is an on-going group that identifies and solves problems; cross-functional on multidisciplinary teams are very
effective in solving problems. A task force is a temporary group that dissolves when the problem is over. A task force researches
into causes of a problem, and recommends corrective action. In some cases, it may be retained to solve the problem. A self-directed
work-team is a group of workers that supervises itself in the identification and solution of problems. It plans, executes,
and evaluates its work.
The first group you belong to is the family. As you grow you become aware of other groups that you belong to: clan,
tribe, nation, religion, and the Ummah. You may freely join groups such as clubs, political parties or you may find yourself
a member of groups such as the school, the university, and the community mosque. Groups may be formal or informal. Most groups
you belong to are informal and you may not even be aware of your membership. Groups can be defined according to social distance
as in-group or out-group. A reference group is one that is accepted as a model. Group work involves people, objectives, and
a situation. A collection of people with no common objective does not constitute
a group. A group of people with a common objective may not constitute a group in certain circumstances; for example when members
of a local football team attend Friday prayers in the mosque, they are not in the mosque as a group because the situation
Traditional society has small intimate groupings that gave people a sense of security. Industrial society is bringing
about anonymity. The medical environment provides an opportunity to work in a multi-disciplinary highly trained team with
its ethics, procedures, and culture. Group-work has its advantages and disadvantages; the advantages far out-weigh the disadvantages.
ADVANTAGES OF GROUP WORK:
Members of groups enjoy the benefits of integration, stimulation, motivation, innovation, emotional support, and
endurance. Group performance is generally superior to individual performance. Abundant exceptions do exist. Some highly productive
people can not work in-groups. This should be accepted. Forcing them to work in groups will only lead to their frustration
and that of the group. Experience throughout history has taught us that productivity and progress are a result of cumulating
of hundreds or even thousands of individual efforts. Individual initiative is the backbone. Societies and systems that suppress
individual initiative eventually fail.
When we talk about group-work being superior we are actually saying that by co-ordinating, channeling, and complementing
activities, as well as canceling contradictions an individual's productivity is higher in a team that outside a team. It is
the individual's productivity and not that of the team that is the yardstick. A team of superior individual performers will
itself be a superiorly performing team. On the other hand a team that is performing well as a team but has some members not
performing to their full potential is essentially a weak team. A team that stifles the individual in the name of conformity
will fail very rapidly. This concept of group-work parallels that of congregational prayer, salat al jamaat. An individual praying in a group gets a 27-fold reward he however still has to perform and take
personal responsibility for results.
DISADVANTAGES OF GROUP-WORK:
The best is to work in groups but like all human endeavors it has its problems and disadvantages that we must be
aware of and must guard against. Members of groups may suffer from the following. They may fall into the trap of group think
when they start feeling that their group is invulnerable, knows, and can do anything. They may start feeling arrogant and
moralize feeling that they are right and everybody else is wrong. The strong to maintain group cohesion may lead to a false
feeling of unanimity when actually people disagree but just suppress their opinions in the interests of the group. There is
pressure on every member to conform to the group norms even if individuals do not agree. Human history has recorded the plight
of individuals who committed many mistakes in order to conform to the group when they knew they were doing wrong. The pressure
on individuals to conform may reach the extent that opposing or different ideas are dismissed. This rapidly leads to destruction
of creativity. Creative individuals with new ideas are not tolerated. Any dissent from the group norm is rejected. The biggest
disadvantage of group work in my view is mis-match of members. Persons who do not share the same vision or who do not have
compatible background experiences can not work together comfortably. Mismatch of group members leads to low group productivity
and even intra-group conflict.
GROUP FORMATION AND BREAK-UP:
There are three bases in the Law for group work: consensus, leadership, and co-operation. The consensus of the
group is protected by Allah from error, al ijma ma'asum. Thus, a group is less
likely to reach a wrong conclusion than an individual working alone. Humans must select and follow a leader for proper and
purposeful conduct of their affairs; this means those followers must congregate in groups under a leader. The general directive
of the Qur'an to believers to co-operate in doing good requires that people work in groups. Some groups are formed by individual
choice. In some cases individuals find themselves put together by circumstances beyond their control.
The health care team falls between these two ends of a spectrum; health care workers freely made the choice of
the medical profession but they can not choose whom to work with in the ward, the clinic, or the operation theater.
There are four stages in group formation. Groups and individuals that compose them go through various stages as
they learn to work together. The four stages are: forming (acquaintance and learning to accept one another), storming (emotions
and tensions), initial integration (start of normal functioning), total integration (full functioning), and dissolution.
Mature groups develop a group identity and have optimized the following characteristics: feedback, decision-making
procedures, cohesion, flexibility of organization, resource utilization, communication, clear goals accepted by members, interdependence,
participation in leadership functions, and acceptance of minority views.
Like everything in life groups are started, they grow and eventually break up. Some groups fail because they are
constituted on the wrong basis. The members can not get along together, communicate with or understand one another. There
is no commonality of interests, attitudes, and goals. In such a case individual effort will be preferable to a non-performing
There are behavioral diseases that destroy groups. All of them have been described and have been defined by the
Qur'an: hasad, nifaq, namiimah, gaybah, kadhb, riyah, kibriyah, hubb al riyasa, tajassus,
and dhun al soo. Seeking personal credit for group work alienates and demotivates. Denying credit where it is due annoys
CHARACTERISTICS OF THE IDEAL GROUP:
An effective group has the following five attributes: First: An ideal
group follows the Qur'an and sunnat in all its activities. It has a common clear and inspiring goal to which the whole group
and its individual members adhere. Having a common goal helps make the group result-oriented. The group has its distinctive
culture and norms. The culture should reflect both underlying Islamic values and the nature of activity. The most important
aspect of culture is to develop a spirit of brotherhood. Group work does not thrive in cultures that instil and encourage
extreme individualism and competition. Group norms help improve interpersonal relations because expectations are clear. Each
group must establish norms defining standards and acceptable behavior. People may adhere to abnormal group norms because of
the need to belong. A strong desire to conform and achieve consensus may be detrimental to a group. Individual members may
be reluctant to challenge wrong assumptions and conclusions of the group. This phenomenon is called groupthink.
Second: Members in the group must feel secure and not suppressed. They
must know that they are accepted in the group as they are with their shortcomings and human weaknesses. They therefore will
express their opinions freely, criticize, and accept criticism.
Third. Understanding and sincere practice of group dynamics that are
necessary for success of group work. Good communication and interaction are the bed-rock of positive group dynamics. Members
must be interdependent, mutually influence one another, and have face-to-face communication. An ideal group should be solid
like a building. Each member should be a brick holding the building together. Members must be loyal to group and to one another.
It will develop a group spirit that puts group interests before individual interests. Members of the group may belong to several
other groups. They may also have several different loyalties. However, these should never deviate from the teachings of Islam.
Group feeling, asabiyyat, is a double-edged sword. In moderation it is positive
in keeping the group together. In the extreme it pits the group against other groups and engenders conflict. It may reach
a stage when truth, fairness, and justice are overlooked in order to maintain group solidarity. Asabiyyat that leads to giving member interests priority over the interests of Islam is strictly forbidden. Group
members must trust one another and not fear that their colleagues will act or talk against them when they turn their back.
A climate of collaboration and Cupertino
in doing good must exist at all times. Group members must share their sorrow, happiness, failure, and success. Openness and
no concealment of facts are the way of life for effective groups. An atmosphere of confidence, trust, and supportive of members.
Fourth. All members must be competent and committed to the group. They
must take both group and personal responsibility for group activities. They must set and adhere to standards of excellence
and superior performance levels. Only good planning, effective organization, and good use of human and material resources
ensure superior performance. The members must understand group roles. There are several ways of cross classifying group roles.
Group roles are of various types: expected, perceived, enacted, and assigned. Groups' roles may be group or individual ones.
Group roles are either task roles (the roles that the group has to carry out) or building and maintenance roles (roles necessary
to maintain the group. Group task roles include: initiating activities, managing activities, collecting and disseminating
information, collection and discussion of opinions, reaching consensus, orientation, setting performance standards, implementation,
evaluation, and control. Group maintenance roles include: encouraging, empowering, harmonizing, setting group norms, conflict
resolution, communication, compromise). Some members in the group may play individual roles. These roles could be negative
but in many cases, they may not be supportive of the group as a whole. Negative individual roles include: aggressor, blocker,
recognition-seeking, player, and dominator, playing politics.
Fifth: Every group must have a leader. Success of a group depends on
the leader. The leader may be assigned or may emerge in the group and becomes accepted by the others. An ideal group leader
should not be selected on the basis of expertise because he may use his power to stifle open discussion. A leader should be
selected on the basis of effective leadership, ability to run meetings well, ability to make sure the work is done, and ability
to hold the group together. Leaders form groups and delegate specific tasks to them. A very directive domineering group leader
may not succeed in leading a performing group because he denies others participation. Group leadership must be principled.
It must have a vision that is shared with all group members. It must encourage talent. The leadership must subject its ego
to group interests. The leader must be able to identify conflicts early and resolve them. A major role for the leader is to
manage conflict to maintain the unity and smooth functioning of the group. When goals, actions, and interests are incompatible,
there is conflict. Conflicts may not always be negative. A group may learn from a conflict situation and emerge stronger.
Poorly managed conflict situations may end with the break-up of the group.
C. ETIQUETTE of TEACHING and LEARNING in THE HEALTH CARE TEAM
COMPOSITION OF THE HEALTH CARE TEAM:
The health care team in a teaching hospital is very complex. It is multi-disciplinary and its members play complementary
and inter-dependent roles. It consists of both university and hospital personnel all engaged in the care of patients. The
academic personnel are the medical faculty as well as the students (under-graduate and post-graduate). The hospital staff
is the consultants, nurses, nursing aides, auxiliary medical personnel. All members of the team have the dual function of
both teaching and delivering health care. The teaching process is complex. There is programmed and structured teaching. However
most of the teaching is passive; there is a lot of learning of attitudes, skills, and facts by being present and watching
what is being done to the patient. There is also continuous learning from one another. Students learn from consultants but
consultants may also get new insights from students.
THE TEACHER'S ETIQUETTE:
Teachers should take their task very seriously. The education process, involving giving and receiving knowledge
is noble (MB#70). Teachers should have the humility to know that their knowledge is limited and that they can always learn
more. Arrogance because of knowledge is condemned (MB#102). Teachers must make the learning process interesting and avoid
boredom (MB#62). They should make the atmosphere and circumstances of learning easy for the students (MB#63). Teachers must
be careful in their actions, attitudes, and words at all times because being models and leaders they are seen and are emulated.
They must be aware that sometimes they can teach using body language without saying anything (MB# 75 and 76); they have to
be careful about their public dispositions They should be ready to carry out their function at all times and at any opportunity
(MB#74). They should have an appropriate emotional expression. They can raise the voice to emphasize an important point (MB#55).
They can show anger or displeasure when a mistake is committed (MB#79, 80, and 81). Asking students questions to ascertain
their level of knowledge is part of the teaching process and is not in any way a humiliation for them (MB#56). Teachers should
make sure that the students understand by constant repetition (MB#82).
THE STUDENT'S ETIQUETTE:
The Islamic etiquette of the relation between the student and the teacher should be followed. In general the student
should respect the teacher. This is respect to knowledge and not the individual. The prophet taught admiration and emulation
of the knowledgeable (MB#66). Students should be quiet and respectfully listen to the teacher all the time (MB#101). Students
should cooperage such that one who attends a teaching session will inform the others of what was learned (MB#78). Students
can learn a lot from one another. The student who hears a fact from a colleague who attended the lecture may even understand
and benefit more (MB#61). Students should ask questions to clarify points that they did not understand or which seem to contradict
previous knowledge and experience (MB#88). Taking notes helps understanding and retention of facts (MB#93). Study of medicine
is a full-time occupation; students should endeavor to stay around the hospital and their teachers all the time so that they
may learn more and all the time. They should avoid being involved in many other activities outside their studies (MB#98).
D. ETIQUETTE of CARE DELIVERY in THE HEALTH CARE TEAM
Each member of the team carries personal responsibility, mas'uliyat
(KS p. 45 and p.338). Leaders of the team carry more responsibility than the others. Leaders must be obeyed (KS p. 44) to
be able to carry out their work well. They however should not be obeyed in committing illegalities, corruption, or oppression,
dhulm (KS p. 45).
The story of Rufaidah is very instructive in the etiquette of medical care for a Muslim. Rufaidah, the first professional
nurse in Islamic history. She lived at the time of the Prophet Muhammad (PBUH) in the 1st century AH/8th
century CE. Her history illustrates all the attributes expected of a good nurse. She was kind and empathetic. She was a capable
leader and organiser able to mobilise and get others to produce good work. She had clinical skills that she shared with the
other nurses whom she trained and worked with. She did not confine her nursing to the clinical situation. She went out to
the community and tried to solve the social problems that lead to disease. She was a public health nurse and a social worker.
Rufaidah is an inspiration for the medical and nursing professions in the Muslim world. Rufaidah bint Sa'ad, is recognized as the first Muslim nurse. Her full name was Rufaidat bint Sa'ad of the Bani
Aslam tribe of the Khazraj tribal confederation in Madinah. She was born in Yathrib before the migration of the Prophet Muhammad
(PBUH). She was among the first people in Madina to accept Islam and was one of the Ansar
women who welcomed the Prophet on arrival in Madina. Rufaidah's father was a physician. She learned medical care by working
as his assistant. Her history illustrates all the attributes expected of a good nurse. She was kind and empathetic. She was
a capable leader and organizer able to mobilize and get others to produce good work. She had clinical skills that she shared
with the other nurses whom she trained and worked with. She did not confine her nursing to the clinical situation. She went
out to the community and tried to solve the social problems that lead to disease. She was both a public health nurse and a
social worker. When the Islamic state was well established in Madina, Rufaidah devoted herself to nursing the Muslim sick.
In peace time she set up a tent outside the Prophet's mosque in Madina where she nursed the sick. During war she led groups
of volunteer nurses who went to the battle-field and treated the casualties. She participated in the battles of Badr, Uhud,
Khandaq, Khaibar, and others. Rufaidah's field hospital tent became very famous during the battles and the Prophet used to
direct that the casualties be carried to her. At the battle of the trench (ghazwat
al khandaq), Rufaidah set up her hospital tent at the battle-field. The Prophet Muhammad (PBUH) instructed that Sa'ad
bin Ma'adh who had been injured in battle be moved to the tent. Rufaidah nursed him, carefully removed the arrow from his
forearm and achieved hemostasis. The prophet visited Sa'ad in the hospital tent several times a day. Sa'ad was to die later
at the battle of Bani Quraidhat. Rufaidah had trained a group of women companions as nurses. When the Prophet's army was getting
ready to go to the battle of Khaibar, Rufaidah
and the group of volunteer nurses went to the Prophet Muhammad (PBUH). They asked him for permission "Oh messenger of
Allah, we want to go out with you to the battle and treat the injured and help Muslims as much as we can". The Prophet gave
them permission to go. The nurse volunteers did such a good job that the Prophet assigned a share of the booty to Rufaidah.
Her share was equivalent to that of soldiers who had actually fought. This was in recognition of her medical and nursing work.
Rufaidah's contribution was not confined only to nursing the injured. She was involved in social work in the community.
She came to the assistance of every Muslim in need: the poor, the orphans, or the handicapped. She looked after the orphans,
nursed them, and taught them. Rufaidah had a kind and empathetic personality that soothed the patients in addition to the
medical care that she provided. The human touch is a very important aspect of nursing that is unfortunately being forgotten
as the balance between the human touch and technology in nursing is increasingly tilted in favor of technology.
History has recorded names of women who worked with Rufaidah: Umm Ammara, Aminah, Umm Ayman, Safiyat, Umm Sulaim,
and Hind. Other Muslim women who were famous as nurses were: Ku'ayibat, Amiinat bint Abi Qays al Ghifariyat, Umm 'Atiyyah
al Ansariyat, and Nusaibat bint Ka'ab al Maziniyyat.
D. THE HEALTH CARE TEAM: GENERAL GROUP DYNAMICS
GENERAL DUTIES AND RIGHTS OF BROTHERHOOD:
The following are general rights of brotherhood that all members of the health care team owe to one another: returning
greetings, following the funeral procession, accepting invitations, visiting the sick, and responding to sneezer. The following
are additional duties: tolerance, forgiveness, helping the oppressed, solving problems, fulfilling needs, compassion and kindness,
gratefulness, protecting the honor of others, fulfilling promises and commitments, respect, sincere advice or nasiiha. It is part of the duties of brotherhood to avoid underrating and humiliating others. It is considered
part of good behavior to remove any annoyance from the public places, imatat al adha
an al tariiq (KS p. 69). In general, everybody must behave with the best of manners, husn
al khulq (KS p. 69).
ETIQUETTE OF INTER-PERSONAL INTERACTION:
Greeting is necessary whenever members meet again even after a short separation. A small group will initiate greeting
the larger group (MB#2057). The walking person initiates greeting the one sitting down (MB #2068). Everybody must be greeted
whether known or not known (MB#2059). Those in an assembly must make room for any new comer (MB#2063). Two individuals should
not engage in secret conversation in the presence of others (MB#2018) because that may create an impression of backbiting
and suspicion. Standing up when a person enters is a sign of respect (KS 67). You should not force a sitting person from his
seat (KS 67). When a person goes away for a temporary period, he has the right to reclaim his seat (KS 67). The following
positive behaviors and attributes should be encouraged in the team: mutual love, tawadud,
and empathetic caring for one another, rahmat & hilm (MB#2018, KS p. 68); leniency,
rifq, in everything (KS p. 68); co-operation and mutual support, ta'awun (MB #2026); generosity, karam (MB #2028); truthfulness, sidq (MB #2039); patience, sabr (MB #2040);
modesty, haya (MB #2043, 2044); cheerful disposition, imbisaat (MB #2045); calling people by their favourite names, ahabb al
asma (MB #2055, 2056); recognising the rights and the position of those older than you, irfan haqq al kabir (KS p. 68); and self control in anger, malk al nafs
inda al ghadhab (KS p. 68). The following negative attributes should be avoided: harshness in speech (MB #2029), rumour
mongering, namiimat (MB #2032), excessive praise of others in their presence, al ghulw fi al thana (MB #2033, KS p. 68), mutual jealousy and turning away from other,
tahasud & taba'ud (MB #2034 & 2035, KS p. 68), avoiding interaction with
a colleague, hijrat, for more than 3 days following a misunderstanding (MB# 2038);
anger, ghadhab (MB #2041); spying on the privacy of others, tatabu'u awrat al nas (KS p. 68); You should avoid repeating the
same mistake twice (MB #2046). It is required not to volunteer information about your personal weaknesses, al satr ala al nafs (MB #2037, KS p. 98), unless it involves correcting a mistake related to the general medical
E. THE HEALTH CARE TEAM: SPECIAL GROUP DYNAMICSThe medical team must of necessity include men and women. The interaction between the two genders is close and continuous
which creates a special situation. Four basic issues arise: (a) manner of dressing (b) mixing of the 2 genders, ikhtilat (c) seclusion of a male with an unrelated female, khalwat
(d) and lowering the gaze, ghadh al basar. Males and females in the team must dress
and behave distinctly. Trans-sexual or unisex dressing and behaviour, takhannuth &
stirjaal, removes the instinctual gender identity. Each gender should maintain
its psychological, emotional identity and physical appearance in manners of dress, walking or speaking. Trying to blur the
distinction interferes with the complementality that is supposed to exist between the two genders. The complementality is
necessary to ensure co-operation. Blurring the differences could also make sexual misconduct easier. The Qur'an forbade free
mixing of the genders, ikhtilat, in general (33:53). Islam fosters a bi-sexual
society. This is however not absolute. There are cases when social and professional intercourse between unrelated men and
women in necessary. It is allowed but with strict precautions to prevent any transgressions. A woman is for example allowed
to serve male guests according to a hadith reported by Bukhari from Sahl Ibn Sa;d al Ansari.
A woman can treat a male patient if there is necessity. A bisexual society does not prevent the women from being an
active member of society. She can pursue her professional interests even outside the home provided she observes the rules
of hijab. Forbidding seclusion of a man with an unrelated woman, khalwat, is a strong temptation for evil and should be avoided. The
prophet forbade a man to be with an unrelated woman in the absence of a third person. When a man is in isolation with an unrelated
woman shaitan is between the two and could lead them astray (hadith reported by Imaam Ahmad on the authority of Amir Ibn Rabiah).
Looking at the opposite sex with desire is prohibited. The eye is a great communication organ. The Qur'an ordered Muslim men
and women to lower their gaze, ghadh al basr (24:30)-31. Lowering the gaze could
be complete or partial. It is partial because of practical necessity. Lowering the gaze doses not mean closing the eyes. It
means being careful not to look fixedly or lustfully at the opposite sex. One of the ways of preventing lustful looks is covering
what is considered nakedness, awrat. Both men and women must be modest by covering
their awrat. Looking at the awrat of
another person is forbidden whether that person is of the same or opposite gender. The prohibition includes both looking with
or without desire (hadith reported by Muslim, Abu Daud, al al Tirmidhi). As part of preventing possible illegal relations,
display of adornments that enhance natural beauty is restricted by the Qur'an (24:31, 33:59)