Эзамен ком навыки АНГ версия Алексеенко

Examination task No.
1
In the discipline " With communication skills"
1.Task.
Student P., who had previously been treated for symptoms of violence and paranoid ideas, told the therapist that he
intended to kill the student. He did not give her name, but based on the information he provided, she could be
identified as T. Campus police were notified, but T's family was not notified. P. was detained by campus police and
later released because the police believed he was sane. T. returned after the holidays, and P. killed her. T's family
sued the university and the therapists for failing to take appropriate steps, which T's parents argue should have
included warning them of the danger their daughter faced. The court granted the claim
Questions:
1. What principle of bioethics is at the center of this situation?
2. What ethical contradiction should have been resolved?
court decision?
3. What are the specifics of the work of a psychiatrist as opposed to a somatic doctor?
4.What is the communicative competence of a doctor and its psychological characteristics?
5. What methods of communication with the patient exist.
1. **Principle of Beneficence and Non-Maleficence:** This situation raises ethical considerations regarding the
duty of healthcare professionals to act in the best interest of their patients while avoiding harm. The therapist had a
duty to protect the potential victim (student T.) from harm, as well as a duty to maintain confidentiality for patient
P. Balancing these duties is central to the principle of beneficence and non-maleficence.
2. **Ethical Contradiction:** The ethical contradiction lies in balancing the duty of confidentiality with the duty to
protect potential victims from harm. While therapists have a duty to maintain patient confidentiality to build trust
and encourage open communication, they also have a duty to protect others from harm. In this case, the therapist
faced a dilemma between respecting patient confidentiality and preventing harm to the potential victim.
3. **Specifics of Psychiatrist's Work vs. Somatic Doctor:** Psychiatrists specialize in diagnosing and treating
mental health disorders, whereas somatic doctors (such as general practitioners or specialists in other medical
fields) primarily focus on physical health conditions. Psychiatrists assess patients' mental health through interviews,
observation, and psychological assessments, and they may prescribe medications or recommend therapy to address
mental health concerns. Somatic doctors, on the other hand, diagnose and treat physical illnesses and injuries
through physical examinations, diagnostic tests, and medical interventions.
4. **Communicative Competence of a Doctor:** Communicative competence refers to a doctor's ability to

effectively communicate with patients, colleagues, and other stakeholders in healthcare settings. Psychological
characteristics that contribute to communicative competence include empathy, active listening skills, cultural
sensitivity, and the ability to establish rapport with patients. A doctor's communicative competence influences their
ability to convey information clearly, facilitate shared decision-making, and address patients' emotional needs.
5. **Methods of Communication with Patients:**

- **Verbal Communication:** This includes spoken interactions between doctors and patients, such as providing
information about diagnoses, treatment options, and preventive care.
- **Nonverbal Communication:** Nonverbal cues, such as body language, facial expressions, and gestures, can
convey empathy, understanding, and reassurance to patients.
- **Written Communication:** Written materials, such as pamphlets, handouts, and educational resources, can
supplement verbal communication and provide patients with additional information to review at home.
- **Digital Communication:** With the advancement of technology, doctors may also communicate with patients
through email, telemedicine platforms, or patient portals, allowing for convenient and timely exchange of
information.
Examination task No. 2

1.Task. A medical college student entered the room after a long absence, said hello, looked around and exclaimed:
“How are you still alive?!” The exclamation was addressed to a seriously ill patient in the ward.
Questions:
1. What consequences may occur for the patient after such a “surprise”?
2. Evaluate the student’s behavior towards a seriously ill patient.
3 Your tactics in this situation.
4.Types of attitude towards illness
5. psychological reactions of patients to the disease
1. **Consequences for the Patient:** Such a "surprise" remark from the student could have several negative
consequences for the patient. It may cause psychological distress, anxiety, or embarrassment for the patient, who
may already be dealing with the emotional burden of their illness. The comment could also undermine the patient's
confidence in their medical care team and create distrust or discomfort in the healthcare environment.
2. **Evaluation of Student's Behavior:** The student's behavior towards the seriously ill patient is highly
inappropriate and insensitive. Making such a remark reflects a lack of empathy, professionalism, and understanding
of the patient's situation. It demonstrates a disregard for the patient's feelings and fails to recognize the seriousness
of their condition. This behavior is not only unprofessional but also potentially harmful to the patient's well-being.
3. **Tactics in this Situation:** In this situation, it's crucial to address the student's behavior promptly and
sensitively. The student should be educated about the importance of empathy, professionalism, and appropriate
communication in healthcare settings. They should be reminded of the impact of their words on patients and the
need to always show respect and compassion, especially towards those who are seriously ill. Additionally, the
patient should be reassured and provided with support to address any distress caused by the student's remark.
4. **Types of Attitude Towards Illness:**

- **Positive Attitude:** Some individuals may adopt a positive attitude towards illness, viewing it as a challenge
to overcome or an opportunity for personal growth. They may focus on maintaining a hopeful outlook, seeking
support from others, and actively engaging in treatment and rehabilitation.
- **Negative Attitude:** Others may have a negative attitude towards illness, feeling overwhelmed, hopeless, or
resigned to their fate. They may struggle with feelings of anger, sadness, or despair and may be less motivated to
participate in their own care or seek support from healthcare providers.
- **Neutral Attitude:** Some individuals may adopt a neutral attitude towards illness, accepting it as a natural
part of life without overly positive or negative emotions. They may approach illness pragmatically, focusing on
practical steps to manage symptoms and maintain their quality of life.
5. **Psychological Reactions of Patients to Disease:**

- **Anxiety:** Patients may experience anxiety related to uncertainty about their diagnosis, prognosis, or
treatment outcomes. They may also worry about the impact of their illness on their daily life, relationships, and
future.
- **Depression:** Chronic or severe illness can lead to feelings of sadness, hopelessness, or despair. Patients may
struggle with changes in their physical abilities, independence, or appearance, leading to depressive symptoms.
- **Denial:** Some patients may initially deny or minimize the seriousness of their illness as a coping
mechanism to protect themselves from distressing emotions. They may resist accepting their diagnosis or engaging
in treatment.
- **Acceptance:** Over time, many patients may come to accept their illness and its limitations. They may focus
on adapting to their circumstances, finding meaning or purpose in their experiences, and making the most of their
lives despite their illness.

1.Task.
A patient who had an appointment with a doctor walked into the office where the nurse was. The nurse responds to
the question “Where is the doctor?” answered that the patient should close the door on the other side, and learned to
read the notices on the doors. The woman was outraged by the rude answer. Having found out that the doctor was
ill, and for the sake of the appointment she took time off from work, she told the nurse about this. To which she
said that it was her problem. The patient called the hotline with a complaint and asked to deal with the rude
behavior of the medical staff.
Questions :
1. Do the professional responsibilities of a nurse include assisting the doctor in organizing patients’ appointments?
2. What kind of violation is this?
3.What is the patient’s psychology , the characteristics of his psyche.
4. The doctor’s behavior with a conflicting patient , which must be taken into account.
5. Communication with patients with mental disorders.
1. **Professional Responsibilities of a Nurse:** Yes, the professional responsibilities of a nurse often include
assisting the doctor in organizing patients' appointments. This may involve scheduling appointments, directing
patients to the appropriate rooms or waiting areas, providing information about the doctor's availability, and
ensuring the smooth flow of patient care in the clinic or office.
2. **Violation:** The nurse's response to the patient's inquiry can be considered a violation of professional conduct
and patient rights. It demonstrates a lack of empathy, respect, and professionalism in communication with patients.
Patients have the right to be treated with dignity, courtesy, and sensitivity, regardless of the circumstances.
3. **Patient's Psychology and Characteristics of Psyche:** The patient in this scenario may experience feelings of
frustration, anger, and disappointment due to the nurse's rude behavior and dismissive attitude. She may feel
disrespected and invalidated, especially after taking time off from work for the appointment. The patient's psyche
may be characterized by a sense of injustice, a need for validation and acknowledgment of her concerns, and a
desire for accountability from the medical staff.
4. **Doctor's Behavior with a Conflicting Patient:** When dealing with a conflicting patient, the doctor must
exercise patience, empathy, and active listening skills. It's essential for the doctor to remain calm, respectful, and
non-confrontational while addressing the patient's concerns. The doctor should acknowledge the patient's feelings,
apologize for any inconvenience or misunderstanding, and offer solutions or alternatives to resolve the issue.
5. **Communication with Patients with Mental Disorders:** When communicating with patients with mental
disorders, healthcare professionals should employ strategies that promote understanding, trust, and rapport. It's
essential to use clear and simple language, provide reassurance and support, and demonstrate empathy and patience.
Active listening, validation of feelings, and collaborative decision-making are crucial in building a therapeutic
alliance and addressing the patient's needs effectively. Additionally, healthcare providers should be mindful of any
specific accommodations or adjustments that may be necessary to ensure effective communication and optimal care
for patients with mental disorders.

1.Task.
The man came to the reception. The doctor ordered examinations for him. He said that he had done these
examinations recently as part of a medical examination and would not undergo them again. He was sent for the
results. The health center's paramedic refused to give him the results. The patient has returned. The doctor wrote
him a note for the paramedic asking him to give the results to the patient. The paramedic said that there were no
ECG and CBC results for this patient’s blood, and that he should go to the prevention department for the results,
and not to the health center. The man returned upset, his blood pressure increased to 180/100. The hypertensive
crisis was complicated by a heart attack.
Exercise:
1. Evaluate the doctor’s actions?
2. Is this a violation?
3.Skills for effective and conflict-free communication with patients, relatives of patients and colleagues.
4. Barriers and solutions to problems that prevent effective communication between doctor and patient
5. The importance of communicative competence for effective and conflict-free interaction between a doctor and a
patient, his family members, and colleagues.
1. **Evaluation of the Doctor's Actions:** The doctor's initial action of ordering examinations for the patient was
appropriate based on the patient's medical history and current condition. However, the doctor should have taken
into account the patient's recent medical examination and should have considered whether repeating the tests was
necessary or if the previous results could be used. Sending the patient to retrieve the results from the health center
was reasonable, but not providing clear instructions on where to obtain them caused confusion. Writing a note for
the paramedic to release the results was a proactive step, but it was ineffective if the paramedic did not have access
to the necessary results. Overall, the doctor's actions lacked clarity and coordination.
2. **Violation:** The refusal of the health center's paramedic to provide the patient with his test results, as well as
the lack of clear communication and coordination between healthcare providers, can be considered violations of
patient rights and professional standards. Patients have the right to access their medical records and test results, and
healthcare providers have an obligation to facilitate this access in a timely and transparent manner.
3. **Skills for Effective and Conflict-Free Communication:** Effective communication skills include active
listening, empathy, clarity, and assertiveness. Healthcare providers should listen to patients' concerns, acknowledge
their feelings, provide clear and accurate information, and advocate for their needs. When communicating with
colleagues, effective communication involves collaboration, mutual respect, and clear exchange of information to
ensure coordinated patient care.
4. **Barriers and Solutions to Communication Problems:** Barriers to effective communication between doctors
and patients may include language barriers, cultural differences, misunderstanding of medical terminology, and
lack of time or resources. Solutions may include using interpreters or language translation services, providing
patient education materials in multiple languages, and using plain language to explain medical concepts. Clear
communication protocols and regular team meetings can help address communication challenges among healthcare
providers.
5. **Importance of Communicative Competence:** Communicative competence is essential for building trust,

fostering patient satisfaction, improving health outcomes, and preventing conflicts in healthcare settings. Effective
communication between doctors and patients, as well as among healthcare team members, enhances patient-
centered care, promotes shared decision-making, and reduces medical errors. It also contributes to a supportive and
collaborative work environment, leading to better patient outcomes and professional satisfaction.

1.Task.
Patient K., 80 years old, was admitted to the emergency department with stroke. The patient's condition is serious.
But admission to the intensive care unit was denied. The patient's relatives were very indignant and demanded an
explanation from the doctor on duty. He motivated his decision by the fact that he did not want to waste his time in
vain, since the patient is elderly and the prognosis of his disease is poor, and at any moment a young patient who is
more likely to have a favorable outcome can be admitted.
Questions :
1. Assess the doctor’s competence?
2. Is this a violation of ethical and deontological rules in medicine ?
3. Features of communication with patients who have cultural and linguistic differences
4. Features of communication with patients with visual impairments ,
5. Features of communication with patients with speech disorders.
1. **Assessment of Doctor's Competence:** The doctor's decision to deny admission to the intensive care unit
based solely on the patient's age and perceived prognosis is highly inappropriate and reflects a lack of competence.
Competent medical decision-making should be based on a thorough assessment of the patient's condition, medical
history, clinical presentation, and treatment options, rather than arbitrary factors such as age. Additionally, the
doctor's dismissive attitude towards the patient and their family members demonstrates a lack of empathy and
professionalism.
2. **Violation of Ethical and Deontological Rules:** Yes, this decision constitutes a clear violation of ethical and
deontological rules in medicine. Every patient has the right to receive appropriate medical care regardless of their
age, and medical decisions should be made in the best interest of the patient's health and well-being. Denying
admission to the intensive care unit based on age discrimination is unethical and contradicts principles of medical
ethics such as beneficence, non-maleficence, and justice.
3. **Communication with Patients with Cultural and Linguistic Differences:** When communicating with patients
who have cultural and linguistic differences, healthcare providers should demonstrate cultural sensitivity, respect,
and empathy. It's essential to use language interpreters or cultural mediators when necessary to ensure effective
communication and understanding. Healthcare providers should also be aware of cultural norms, beliefs, and
practices that may influence the patient's healthcare decisions and preferences.
4. **Communication with Patients with Visual Impairments:** When communicating with patients with visual
impairments, healthcare providers should use verbal communication effectively, providing clear and detailed
explanations of medical information. They should also offer assistance with navigating the healthcare environment
and accessing written materials in alternative formats, such as large print or braille. Using verbal cues and
descriptive language can help patients with visual impairments understand their surroundings and medical
procedures.
5. **Communication with Patients with Speech Disorders:** When communicating with patients with speech
disorders, healthcare providers should be patient, attentive, and supportive. They should encourage the patient to
communicate in their preferred mode, whether it's verbal speech, sign language, or augmentative and alternative
communication (AAC) devices. Healthcare providers should listen actively, provide ample time for the patient to
express themselves, and avoid interrupting or finishing their sentences. Additionally, using visual aids, written
instructions, or pictures can enhance communication and understanding for patients with speech disorders.

The form of the exam: written.

Type of task: Practice-oriented task.
1.Task:
The doctor prescribed the patient Z. diphenhydramine . Soon after using the drug, it turned out that the patient had
developed a spasm of the respiratory tract. When checking, it turned out that the doctor did not indicate the required
dosage of the drug in the prescription. Due to the complication, the victim wrote a complaint that the doctor was
negligent about her health and demanded compensation for material damage.
Questions:
1. Doctor's mistakes
2. Is the patient’s complaint justified?
this situation could have been avoided
4. Communicative and ethical problems of dying, resuscitation and death
5. Achieving initial mutual understanding.
1. **Doctor's Mistakes:** The doctor made several mistakes in this situation:

- Failure to specify the required dosage of the drug (diphenhydramine) in the prescription, which led to the
patient's incorrect administration of the medication.
- Prescribing a medication without ensuring that the patient's medical history and potential contraindications were
adequately assessed.
- Failing to monitor the patient closely after prescribing the medication, which could have allowed for early
detection of adverse reactions.
2. **Patient's Complaint Justification:** Yes, the patient's complaint is justified. The doctor's negligence in
prescribing the medication without specifying the dosage directly led to the patient experiencing a severe adverse
reaction, namely a spasm of the respiratory tract. This adverse event caused harm to the patient's health and
necessitated further medical intervention. Therefore, the patient's demand for compensation for material damage
resulting from the complication is reasonable.
3. **Avoiding the Situation:** This situation could have been avoided if the doctor had:
- Taken a thorough medical history, including any allergies or previous adverse reactions to medications.
- Conducted a proper assessment of the patient's condition before prescribing the medication.
- Clearly specified the dosage and administration instructions for the prescribed medication in the prescription.
- Provided adequate patient education about the medication, including potential side effects and what to do in case
of adverse reactions.
- Monitored the patient closely after prescribing the medication to promptly identify and address any adverse
reactions.
4. **Communicative and Ethical Problems of Dying, Resuscitation, and Death:** In situations involving dying,
resuscitation, and death, healthcare providers face significant communicative and ethical challenges. These include:
- Communicating effectively with patients and their families about end-of-life care decisions, prognosis, and
treatment options.
- Ensuring patient autonomy and dignity while respecting their wishes and preferences regarding resuscitation and
life-sustaining treatments.
- Managing emotions and providing emotional support to patients, families, and colleagues during difficult and
emotionally charged situations.
- Upholding ethical principles such as beneficence, non-maleficence, and respect for patient autonomy in end-of-
life care decision-making.
5. **Achieving Initial Mutual Understanding:** Achieving initial mutual understanding in healthcare requires
effective communication and rapport-building between healthcare providers and patients. This can be achieved by:
- Active listening to the patient's concerns, preferences, and expectations.
- Providing clear and accurate information about the patient's condition, treatment options, and potential risks and
benefits.
- Using plain language and avoiding medical jargon to ensure understanding.
- Encouraging open dialogue and addressing any questions or uncertainties the patient may have.
- Demonstrating empathy, compassion, and respect for the patient's values and beliefs.
- Collaborating with the patient in decision-making and involving them as partners in their care.


1. Task
A 45-year-old patient has been undergoing treatment in the cardiology department for a month . He very much
doubts all the procedures that are performed on him as prescribed by the doctor, and does not believe in the success
of the treatment. During procedures, he argues with the nurse, often has a smirk on his face, and may not show up
for scheduled tests. The nurse tried to talk to the patient, but he does not listen to her, is rude, and hides his eyes.
The nurse managed to find out during the conversation that the patient had a negative experience with the medical
staff.
Questions:
1.Tactics of the Doctor
2.What effect of communication did the patient receive, how to fix it.
3.What is the impetus for the conflict to occur?
4. Strategies for behavior in a conflict situation.
5. Personality questionnaires , clinical standardized scale assessment methods
and self-assessment of patients' condition.
1. **Tactics of the Doctor:** The doctor should:

- Schedule a meeting with the patient to address his concerns and discuss his doubts about the treatment.
- Listen actively to the patient's perspective and acknowledge his feelings and experiences.
- Provide clear explanations about the rationale behind the prescribed procedures and the expected benefits of the
treatment.
- Offer reassurance and empathy to alleviate the patient's anxiety and build trust in the medical team.
- Collaborate with the patient in developing a treatment plan that takes into account his preferences and addresses
his doubts.
- Involve other members of the healthcare team, such as a psychologist or counselor, if necessary, to provide
additional support and counseling to the patient.
2. **Effect of Communication on the Patient and How to Fix It:** The patient likely feels unheard, misunderstood,
and distrustful due to negative past experiences with medical staff. To fix this, the healthcare team should:
- Validate the patient's feelings and acknowledge the impact of his past experiences on his current behavior.
- Use empathetic communication to create a supportive and non-judgmental environment where the patient feels
comfortable expressing his concerns.
- Reiterate the importance of the prescribed procedures and the potential benefits of the treatment in improving
his health and well-being.
- Offer alternative communication methods, such as written materials or videos, to supplement verbal
explanations and enhance the patient's understanding.
- Build a therapeutic alliance with the patient based on mutual respect, trust, and collaboration to foster a positive
therapeutic relationship.
3. **Impetus for the Conflict:** The conflict likely arises from the patient's underlying anxiety, fear, and mistrust
stemming from negative past experiences with medical staff. These experiences may have led the patient to develop
a defensive and confrontational attitude towards healthcare professionals, causing him to doubt the necessity and
efficacy of the prescribed treatment.
4. **Strategies for Behavior in a Conflict Situation:** Strategies for managing conflicts with the patient include:
- Remaining calm and composed, avoiding escalation of the situation.
- Using active listening and empathy to understand the patient's perspective and concerns.
- Setting clear boundaries and expectations for respectful behavior during interactions with the patient.
- Offering support and reassurance to address the patient's fears and anxieties.
- Seeking assistance from colleagues or supervisors if the situation becomes unmanageable or requires additional
intervention.
5. **Personality Questionnaires, Clinical Standardized Scale Assessment Methods, and Self-Assessment of

Patients' Condition:** These assessment tools can be used to:
- Identify underlying psychological factors contributing to the patient's behavior, such as anxiety, depression, or
personality traits.
- Evaluate the severity of the patient's symptoms and their impact on his daily functioning and quality of life.
- Monitor changes in the patient's condition over time and assess the effectiveness of interventions and treatments.
- Facilitate communication and rapport-building between healthcare providers and patients by providing a
structured framework for understanding and addressing the patient's needs and concerns.


1.Task :
A young woman, 32 years old, consulted an obstetrician-gynecologist about pregnancy. From her life history it is
known that she had rubella. This disease in the early stages causes congenital deformities in 60-70% of cases. The
doctor advised the woman to terminate the pregnancy, arguing that she would give birth to a freak . The woman
began to get nervous and her condition worsened sharply.
Questions :
1. A barrier to relationships arises in the process of communication
2.What are the first signs of conflict?
3. Competence of the doctor in this situation
4. Methods for resolving interpersonal conflicts
5. Joint search for a way out of the doctor-patient conflict situation
1. **Barrier to Relationships:** The barrier to the doctor-patient relationship arises from the doctor's insensitive
and stigmatizing language, which can cause distress and emotional harm to the patient. The doctor's use of the term
"freak" to describe the potential outcome of the pregnancy is inappropriate and disrespectful, creating a significant
barrier to effective communication and trust between the doctor and the patient.
2. **First Signs of Conflict:** The first signs of conflict in this situation include:
- The patient becoming nervous and experiencing a sharp worsening of her condition in response to the doctor's
advice.
- The breakdown of trust and rapport between the doctor and the patient due to the insensitive and stigmatizing
language used by the doctor.
- The patient feeling invalidated and judged by the doctor's recommendation to terminate the pregnancy based on
assumptions about potential congenital deformities.
3. **Competence of the Doctor:** In this situation, the doctor demonstrates a lack of competence in several key
areas:
- Communication: The doctor's use of stigmatizing language and failure to provide empathetic and supportive
counseling contribute to a breakdown in the doctor-patient relationship.
- Sensitivity and Cultural Competence: The doctor fails to recognize the impact of her words on the patient's
emotional well-being and overlooks the importance of providing culturally sensitive care.
- Ethical Considerations: The doctor's recommendation to terminate the pregnancy based on assumptions about
potential congenital deformities without considering the patient's individual circumstances and preferences raises
ethical concerns about patient autonomy and beneficence.
4. **Methods for Resolving Interpersonal Conflicts:** Some methods for resolving interpersonal conflicts in this
situation include:
- Active Listening: The doctor should listen attentively to the patient's concerns and validate her emotions without
judgment.
- Empathy: The doctor should demonstrate empathy and understanding towards the patient's anxieties and fears
about the pregnancy.
- Clear Communication: The doctor should communicate clearly and sensitively, avoiding stigmatizing language
and providing accurate information about the risks and options available to the patient.
- Collaboration: The doctor and patient should work together collaboratively to explore all available options for
managing the pregnancy and making informed decisions that align with the patient's values and preferences.
- Conflict Resolution Techniques: If tensions escalate, the doctor should employ conflict resolution techniques
such as mediation or involving a neutral third party to facilitate constructive dialogue and find a mutually
acceptable resolution.
5. **Joint Search for a Way Out of the Doctor-Patient Conflict Situation:** Both the doctor and the patient should
actively engage in a joint search for a way out of the conflict situation by:
- Acknowledging the breakdown in communication and trust and expressing a willingness to address the
underlying issues.
- Engaging in open and honest dialogue about the patient's concerns, preferences, and goals for the pregnancy.
- Exploring alternative options and strategies for managing the pregnancy, taking into account the patient's
individual circumstances and values.
- Seeking input from other healthcare providers or specialists, if necessary, to provide comprehensive and
multidisciplinary care tailored to the patient's needs.
- Working towards rebuilding trust and rapport in the doctor-patient relationship through mutual respect,
empathy, and collaborative decision-making.

1.Task :
Three years ago Nikolai had surgery for adenoma
prostate gland. The postoperative period was difficult, and six months later Nikolai developed a stricture
(narrowing) of the urinary canal, which required repeat surgery.
The essence of the conflict is this:
- the patient claims that he was not warned about the possible consequences of the operation, otherwise he would
not have agreed to it, and demands compensation for moral damage caused;
— doctors are confident that a conversation with the patient took place before the operation, and do not consider
themselves guilty in this situation.
Questions:
1. Define a bioethical problem.
2. Why did the conflict arise between doctors and patients?
Explain.
3. What bioethical principles were not violated by doctors?
4. Levels of communication, their characteristics.
1. **Bioethical Problem:** The bioethical problem at the center of this conflict revolves around informed consent
and patient autonomy. Nikolai claims that he was not adequately informed about the potential consequences of the
prostate surgery, leading to complications that significantly impacted his quality of life. The conflict arises from the
perceived breach of trust and lack of autonomy in the decision-making process regarding his medical treatment.
2. **Conflict Origin:** The conflict between doctors and the patient likely arose due to miscommunication or
misunderstanding regarding the informed consent process. Nikolai feels that he was not adequately informed about
the potential risks and consequences of the surgery, leading to feelings of betrayal and resentment. On the other
hand, doctors may believe that they provided sufficient information during the preoperative consultation, but there
may have been a breakdown in communication or documentation of this conversation. Additionally, differing
perceptions of what constitutes "adequate" information could contribute to the conflict.
3. **Unviolated Bioethical Principles:** While the specific details of the case are not provided, it is possible that
doctors did not violate bioethical principles such as beneficence and nonmaleficence. They likely acted in the
patient's best interest by recommending surgery to address the adenoma prostate gland, aiming to improve Nikolai's
health and quality of life. However, the conflict highlights potential shortcomings in upholding the principles of
autonomy and respect for patient preferences, as Nikolai feels his autonomy was not adequately respected.
4. **Levels of Communication:**
- **Intrapersonal Communication:** Nikolai's internal dialogue and decision-making process regarding his
medical treatment.
- **Interpersonal Communication:** Communication between Nikolai and his healthcare providers, including
doctors and nurses, regarding his medical condition, treatment options, and informed consent.
- **Organizational Communication:** Communication within the healthcare facility, including policies and
procedures related to obtaining informed consent and documenting patient interactions.
- **Public Communication:** Communication between healthcare providers and the public regarding healthcare
practices, patient rights, and medical ethics.
5. **Methods for Resolving Interpersonal Conflicts:**

- **Open Communication:** Encourage open and honest dialogue between Nikolai and his healthcare providers
to address misunderstandings and concerns regarding the informed consent process.
- **Mediation:** Engage a neutral third party, such as a patient advocate or mediator, to facilitate communication
and negotiation between Nikolai and his healthcare providers.
- **Conflict Resolution Techniques:** Utilize conflict resolution techniques such as active listening, empathy,
and compromise to find mutually acceptable solutions to the conflict.
- **Documentation Review:** Review medical records and documentation of the preoperative consultation to
determine if informed consent was adequately obtained and documented.
- **Ethics Consultation:** Seek guidance from medical ethics committees or ethics consultants to navigate
complex bioethical issues and ensure adherence to ethical principles in resolving the conflict.


1.Task :
A patient with bronchitis was prescribed streptomycin. However, while giving him the medicine, the pharmacist
asked: “Do you have tuberculosis?”
The patient replied: “No.” Arriving home, the patient felt sweating, weakness, and remembered that he had been in
contact with tuberculosis
sick and developed tuberculosisophobia (an obsessive fear of getting tuberculosis).
Questions:
2. What is before us: egrotogeny , iatrogeny, egogeny , sisterstrogeny ? Explain.
3. Did the pharmacist violate ethical principles with her question?
1. **Bioethical Problem:** The bioethical problem in this scenario revolves around patient confidentiality, trust,
and the pharmacist's duty to inquire about potential contraindications or risks associated with medication.
Additionally, the patient's fear of developing tuberculosis due to the pharmacist's question raises concerns about
patient autonomy and psychological well-being.
2. **Type of Problem: Iatrogeny:** Iatrogeny refers to harm caused by medical intervention or treatment. In this
case, the patient's fear and anxiety about developing tuberculosis were exacerbated by the pharmacist's question,
potentially leading to psychological distress and worsening of symptoms. The pharmacist's inquiry inadvertently
triggered the patient's fear and anxiety, resulting in negative consequences.
3. **Violation of Ethical Principles:** The pharmacist's question may be considered a breach of patient
confidentiality and privacy, as it delved into the patient's medical history without a clear medical need. While the
pharmacist may have had good intentions in ensuring the safety and appropriateness of the prescribed medication,
the manner in which the question was asked could have been perceived as intrusive or insensitive. Ethical
principles of respect for patient autonomy and privacy should guide healthcare professionals' interactions with
patients.
4. **Resolving the Conflict:**

- Open Communication: Encourage open and empathetic communication between the patient and the pharmacist
to address the patient's concerns and provide reassurance.
- Explanation: The pharmacist can explain the rationale behind the question and apologize for any unintended
distress caused.
- Psychological Support: Offer psychological support and resources to help the patient cope with their fear and
anxiety, such as counseling or support groups.
- Reassurance: Provide reassurance regarding the safety and appropriateness of the prescribed medication for
treating bronchitis.
5. **Levels of Communication:**
- **Intrapersonal Communication:** The patient's internal processing of emotions, thoughts, and fears about the
pharmacist's question and the potential risk of tuberculosis.
- **Interpersonal Communication:** Communication between the patient and the pharmacist during the
medication dispensing process, including the pharmacist's question and the patient's response.
- **Organizational Communication:** Communication within the healthcare organization regarding policies and
procedures related to patient confidentiality and privacy, as well as protocols for medication dispensing.
- **Public Communication:** Communication to the broader public about the importance of respecting patient
privacy and confidentiality in healthcare settings, as well as the impact of healthcare professionals' words and
actions on patient well-being.

1.Task :
He was taken to the children's city hospital by his parents
A 7-year-old child diagnosed with anemia. An urgent blood transfusion was required. The parents refused this
procedure, citing the fact that their religious beliefs did not allow them to do so. Doctors did not do this procedure.
The child died because he was not given a blood transfusion in a timely manner.
Questions:
2. Are the doctors right in not saving the child’s life?
3. Effectiveness of the communication process in healthcare
4. Professional communication in the formation of health conservation
5. Psychological factors of a doctor’s communicative competence
1. **Bioethical Problem:** The bioethical problem in this scenario revolves around the conflict between the
parents' religious beliefs and the medical necessity of a blood transfusion to save the child's life. It raises questions
about patient autonomy, parental rights, the best interests of the child, and the balance between respecting cultural
or religious beliefs and ensuring the provision of necessary medical care.
2. **Ethical Dilemma:** The doctors faced a complex ethical dilemma. While they have a duty to respect the
parents' religious beliefs and autonomy, they also have a duty to act in the best interests of the child's health and
well-being. In this case, the child's life was at risk due to severe anemia requiring urgent treatment with a blood
transfusion. The doctors had a moral and professional obligation to provide the necessary medical intervention to
save the child's life, even if it conflicted with the parents' religious beliefs.
3. **Communication Effectiveness:** The effectiveness of communication in healthcare involves clear,

empathetic, and culturally sensitive communication between healthcare providers and patients or their families. In
this scenario, effective communication could have involved:
- Explaining the medical necessity of the blood transfusion to the parents in a sensitive and understandable
manner.
- Listening to the parents' concerns and addressing them with empathy and respect.
- Collaborating with the parents to explore alternative solutions or accommodations that align with their religious
beliefs while ensuring the child receives necessary medical treatment.
- Involving a hospital ethicist or religious counselor to facilitate communication and negotiation between the
medical team and the parents.
4. **Professional Communication in Health Conservation:** Professional communication in healthcare involves

conveying medical information, discussing treatment options, and collaborating with patients or their families to
make informed decisions about their care. In this case, effective professional communication could have helped
bridge the gap between the medical team and the parents' religious beliefs. It could have involved:
- Clear explanation of the medical condition, treatment options, and potential risks and benefits of interventions.
- Respectful consideration of the parents' religious beliefs and values, while emphasizing the urgency and
importance of the recommended medical intervention.
- Collaboration with religious or cultural advisors to find solutions that respect both the medical necessity and the
parents' religious beliefs.
5. **Psychological Factors of a Doctor's Communicative Competence:** A doctor's communicative competence

involves not only conveying medical information effectively but also understanding and addressing the
psychological factors that influence patient or parental decision-making. In this scenario, the doctors could have
considered:
- The emotional distress and anxiety experienced by the parents, which may have influenced their decision-
making.
- The cultural and religious beliefs that shape the parents' worldview and decision-making process.
- Empathetic communication to build trust and rapport with the parents, which could facilitate shared decision-
making and adherence to medical recommendations.
- Awareness of their own biases and prejudices, and their impact on communication and decision-making
processes.

Doctor M., a young anesthetist at the city hospital, is called

chief surgeon in the operating room. The surgeon uses outdated technologies, which lengthen the operation and
lead to more severe postoperative pain and increased recovery time. Moreover, he often makes rude jokes towards
patients and nursing staff. As a young specialist, Dr. M. is afraid and does not really want to criticize the surgeon in
front of everyone or report the facts to higher management. However, he feels that something needs to be done to
change the situation.
Questions:
1. Identify the moral problem facing Dr. M.
2. What do you advise Dr. M to do? Explain.
3. How does the Doctor’s Code of Ethics regulate such a situation?
4. Iatrogenesis, medical errors. Ways to reduce them.
5. Professional deformation of doctors of various specialties
1. **Moral Problem:** Dr. M faces a moral dilemma concerning patient safety, professional integrity, and ethical
conduct in the workplace. The surgeon's use of outdated technologies, inappropriate behavior, and disregard for
patient well-being present ethical challenges for Dr. M. He is torn between his duty to ensure quality patient care
and his fear of confronting the surgeon or reporting the situation to higher authorities.
2. **Advice for Dr. M:**

- **Document the Concerns:** Dr. M should start by documenting specific instances of the surgeon's behavior,
including the use of outdated technologies, inappropriate jokes, and any adverse patient outcomes resulting from
these practices. This documentation will provide evidence to support his concerns.
- **Seek Support:** Dr. M should seek support from colleagues, mentors, or hospital administrators who may be
able to offer guidance and assistance in addressing the situation.
- **Address the Issue Privately:** Dr. M could consider addressing the surgeon privately, expressing his
concerns about patient safety and the need for updated practices in the operating room. Approaching the surgeon in
a respectful and non-confrontational manner may help facilitate a constructive dialogue.
- **Report to Higher Authorities:** If the issue persists or if Dr. M feels uncomfortable addressing it directly
with the surgeon, he should report his concerns to hospital management or the appropriate regulatory bodies.
Patient safety should always be the top priority, and reporting unethical or unsafe practices is essential to uphold
professional standards.
- **Advocate for Change:** Dr. M can advocate for change within the hospital by proposing improvements to
surgical protocols, promoting ongoing education and training for staff, and fostering a culture of respect and
professionalism in the workplace.
3. **Doctor's Code of Ethics:** The Doctor's Code of Ethics typically includes principles such as beneficence, non-
maleficence, patient autonomy, and professional integrity. In this situation, Dr. M's ethical responsibilities include
advocating for patient safety, addressing professional misconduct, and upholding the standards of medical practice.
Reporting concerns about outdated technologies, inappropriate behavior, and patient harm aligns with these ethical
principles.
4. **Iatrogenesis and Medical Errors:** Iatrogenesis refers to harm caused by medical treatment or intervention,
while medical errors encompass mistakes or failures in healthcare delivery that result in harm to patients. Ways to
reduce iatrogenesis and medical errors include:
- Implementing evidence-based practices and guidelines to ensure safe and effective care.
- Providing ongoing training and education for healthcare professionals to enhance clinical skills and knowledge.
- Establishing robust quality improvement and patient safety initiatives within healthcare institutions.
- Encouraging open communication, teamwork, and a culture of reporting and learning from errors.
- Utilizing technology and systems to minimize risks, such as electronic health records and medication
management systems.
5. **Professional Deformation:** Professional deformation refers to the gradual erosion of professional values,
ethics, and standards due to various factors such as stress, burnout, organizational culture, or personal attitudes. It
can manifest differently in doctors of various specialties but often leads to compromised patient care, decreased job
satisfaction, and ethical lapses. Addressing professional deformation requires support systems, self-awareness, and
organizational interventions aimed at promoting physician well-being, resilience, and adherence to ethical
standards.


1.Task:
Here are the doctors' remarks:
* Dentist: “Of course, you can make a cheap filling, but why would I then spend an hour and a half on the work. Go
to the “ district clinic” or pay 7,000 tenge here for a reflective filling.”
* Therapist: “I will tell you the test results for 200 tenge , which cost a repeat visit! Whoever was paid 500 tenge
for the initial examination, go to him for an interpretation.”
Questions:
1. Identify the bioethical problems of medical remarks.
2. What “ clash ” of values is represented in these remarks?
3. Skills for effective and conflict-free communication with patients, relatives of patients and colleagues.
4. Barriers and solutions to problems that impede effective communication between doctor and patient.
5. Types of attitude towards illness.
1. **Bioethical Problems:**
- Both remarks exhibit a lack of professionalism, empathy, and respect for patients.
- The dentist's remark prioritizes profit over patient care, suggesting that a cheaper option is not worth the
dentist's time.
- The therapist's remark demonstrates a disregard for patient confidentiality and ethical standards by charging
patients for test results and deflecting responsibility for interpretation.
2. **Clash of Values:**
- The remarks reflect a clash between the values of patient-centered care, ethical conduct, and financial interests.
- While healthcare providers have a duty to prioritize patient well-being and uphold professional ethics, the
remarks prioritize financial gain and convenience for the healthcare provider.
3. **Skills for Effective Communication:**

- Active Listening: Healthcare providers should listen attentively to patients' concerns and needs without
judgment or interruption.
- Empathy and Compassion: Demonstrating empathy and understanding can help build rapport and trust with
patients.
- Clear and Transparent Communication: Healthcare providers should communicate information clearly, honestly,
and respectfully, ensuring that patients understand their options and treatment plans.
- Conflict Resolution: Healthcare providers should be skilled in managing conflicts and addressing disagreements
with patients or colleagues in a constructive and respectful manner.
- Cultural Sensitivity: Being culturally sensitive and aware of patients' backgrounds, beliefs, and values can help
prevent misunderstandings and enhance communication.
4. **Barriers to Effective Communication:**

- Lack of Time: Healthcare providers may feel rushed or overwhelmed, leading to communication breakdowns or
errors.
- Hierarchical Structures: Power differentials within healthcare settings can inhibit open communication and
collaboration between healthcare providers and patients.
- Language and Cultural Barriers: Differences in language, cultural norms, and health literacy levels can impede
effective communication and understanding.
- Emotional Distress: Patients experiencing fear, anxiety, or distress may have difficulty communicating their
needs or understanding medical information.
- Lack of Training: Healthcare providers may lack training or skills in effective communication techniques,
leading to misunderstandings or conflicts.
5. **Types of Attitude Towards Illness:**

- Biomedical Model: This attitude views illness as a physical malfunction or disease process that requires medical
intervention to cure or manage symptoms.
- Biopsychosocial Model: This approach considers illness as influenced by biological, psychological, and social
factors, recognizing the importance of holistic care and addressing underlying causes.
- Patient-Centered Care: This attitude prioritizes the patient's preferences, values, and goals in decision-making,
emphasizing collaboration, empathy, and shared decision-making between patients and healthcare providers.
- Holistic Approach: This attitude considers the interconnectedness of mind, body, and spirit in health and illness,
emphasizing lifestyle factors, emotional well-being, and social support in healthcare delivery.


1.Task :
Sergeevka North Kazakhstan region, 2004. A 6-year-old girl was bitten by a dog. The parents brought the girl to the
medical center, where the doctors performed initial treatment of the wound and sent the victim home, without even
informing the parents that it was necessary to vaccinate against rabies. After 1.5 months the girl died. Doctors and
nurses were brought to administrative responsibility.
Questions:
2. Are there any violations of ethical standards and principles on the part of doctors?
3. Is the punishment in the form of administrative liability for the death of the patient proportionate?
4. Conflict structures in medical practice
5. Medical communication techniques : listening techniques
1. **Bioethical Problem:**
- The bioethical problem in this scenario revolves around the duty of healthcare providers to adequately inform
and protect patients, especially in cases where there is a risk of serious harm, such as rabies transmission from a
dog bite.
- Failure to provide appropriate information and preventive measures, such as rabies vaccination, constitutes a
breach of patient trust and raises questions about the ethical responsibility of healthcare providers.
2. **Violations of Ethical Standards:**

- The doctors' failure to inform the parents about the necessity of rabies vaccination after a dog bite constitutes a
violation of ethical principles such as beneficence (acting in the patient's best interest) and autonomy (respecting
the patient's right to make informed decisions about their health).
- Additionally, the lack of proactive measures to prevent rabies transmission, despite being aware of the risk
associated with dog bites, reflects a failure in the duty of care owed to the patient.
3. **Proportionality of Punishment:**
- While administrative liability may seem severe, it serves to highlight the seriousness of the breach of duty by
healthcare providers in this case.
- The death of the patient due to a preventable cause underscores the gravity of the situation and the need for
accountability.
- Administrative liability acts as a deterrent and emphasizes the importance of upholding ethical standards and
ensuring patient safety in healthcare practice.
4. **Conflict Structures in Medical Practice:**

- Power Dynamics: There may have been a power dynamic at play where healthcare providers failed to
adequately communicate with or listen to the concerns of the parents, leading to a breakdown in patient-provider
trust.
- Communication Barriers: Miscommunication or lack of communication regarding the necessity of rabies
vaccination may have contributed to the conflict between the healthcare providers and the parents.
- Ethical Dilemmas: Healthcare providers may have faced ethical dilemmas regarding the balance between
respecting parental autonomy and ensuring the best interests of the child, which could have influenced their actions
or lack thereof.
5. **Medical Communication Techniques - Listening Techniques:**

- Active Listening: Healthcare providers should actively listen to the concerns and questions of patients and their
families, acknowledging their perspectives and addressing their information needs.
- Empathetic Communication: Demonstrating empathy and understanding can help build rapport and trust with
patients and their families, facilitating open communication and collaboration in decision-making.
- Clarification: Healthcare providers should clarify information and ensure that patients and their families fully
understand their condition, treatment options, and preventive measures, such as vaccination after a dog bite.
- Open-Ended Questions: Asking open-ended questions can encourage patients and their families to share their
thoughts, concerns, and preferences, facilitating a more comprehensive understanding of their needs and
expectations.


1.Task:
A patient with a stomach ulcer with long-term treatment and persistent pain syndrome completely lost heart from a
certain day and lost his appetite. I started losing weight. Upon questioning, it turned out that in a conversation with
him the doctor asked: “Which of your closest relatives died of cancer?” The patient did have some signs of
malignancy of the ulcer (persistence of pain, weight loss, decreased stomach function). A careless question
convinced the patient of the correctness of his assumption about the presence of a malignant process, the absence of
which was later confirmed by the results of a biopsy and the subsequent favorable course of the disease.
Questions:
2. Which bioethical principle and which deontological
Did the doctor break the rule in his conversation with the patient?
3. What type of patient is most often susceptible to egogenia ?
5.Techniques and algorithms for effective communication in medicine
- The bioethical problem in this scenario involves the impact of the doctor's careless question on the patient's
psychological well-being and medical decision-making.
- The patient's assumption about having cancer based on the doctor's question led to significant distress, anxiety,
and loss of appetite, which ultimately affected the patient's quality of life and treatment adherence.
2. **Violation of Bioethical Principle and Deontological Rule:**

- The doctor violated the principle of beneficence, which requires healthcare providers to act in the best interest of
the patient. By asking a careless question that unnecessarily alarmed the patient and led to psychological distress,
the doctor failed to uphold the patient's well-being.
- Additionally, the doctor breached the deontological rule of non-maleficence, which emphasizes the obligation to
avoid causing harm to patients. The careless question contributed to the patient's emotional distress and negative
psychological impact, thus violating the principle of non-maleficence.
3. **Patients Susceptible to Egogeny:**

- Patients who are already experiencing psychological distress or anxiety related to their medical condition are
more susceptible to egogeny.
- Individuals who have a tendency to catastrophize or excessively worry about their health may also be vulnerable
to egogeny, as they may interpret ambiguous or careless remarks from healthcare providers in a negative and
alarming manner.
4. **Levels of Communication and Characteristics:**

- Informative Communication: This level involves providing factual information to patients about their medical
condition, treatment options, and prognosis. It should be clear, accurate, and tailored to the patient's level of
understanding.
- Supportive Communication: This level focuses on addressing the emotional and psychological needs of patients,
offering empathy, reassurance, and encouragement during challenging times.
- Therapeutic Communication: This level aims to foster a collaborative and trusting relationship between
healthcare providers and patients, emphasizing mutual respect, active listening, and shared decision-making.
5. **Techniques and Algorithms for Effective Communication in Medicine:**

- Empathetic Listening: Healthcare providers should actively listen to patients' concerns, validate their emotions,
and demonstrate empathy and understanding.
- Clear and Open Communication: Information should be conveyed in a clear, jargon-free manner, and patients
should be encouraged to ask questions and express their thoughts and concerns.
- Addressing Patient Anxiety: Healthcare providers should acknowledge and address patient anxiety and distress,
providing reassurance, support, and appropriate information to alleviate fears and uncertainties.
- Avoiding Ambiguous or Alarmist Language: Healthcare providers should be mindful of the language they use,
avoiding ambiguous or alarming statements that may unnecessarily worry or distress patients.


1.Task:
Children's doctor S. Ivanov says: “At night they called me to the department. A 3-month-old baby was admitted in
serious condition. The mother screamed hysterically: “I won’t let you!” I won’t let her give injections!” I took the
child away by force and ordered the nurse to lock the mother in the pantry. And we began to revive the girl. They
pierced the head - and in vain! Only on the wrist, by some miracle, was it possible to enter a vein, and we infused
everything we wanted. The mother screamed from the pantry: “I’ll hang myself! I'll kill myself! The nurse got
scared and released the neuropathic woman . She burst into the nurse's room and tried to take the child away. I was
forced to throw her out into the corridor. We finished fiddling around at 5 o'clock in the morning. But the girl was
pink and breathing well.
Questions:
2. Which model of the “doctor-patient” relationship did Doctor Ivanov’s actions correspond to: paternalistic or
informed consent?
3. Is every doctor capable of such an act? Explain.
4. Ethics in medicine.
5. Legal responsibility of the doctor for communicative incompetence (patient complaint).
- The bioethical problem in this scenario involves the violation of patient autonomy and the use of force against
the mother to provide medical treatment to the infant without her consent. It also raises concerns about the
emotional well-being and rights of both the mother and the child during medical emergencies.
2. **Model of Doctor-Patient Relationship:**

- Doctor Ivanov's actions correspond to a paternalistic model of the doctor-patient relationship. In a paternalistic
approach, the doctor assumes the role of decision-maker and acts in what they believe to be the best interest of the
patient, often without considering the patient's preferences or autonomy. By forcibly taking the child away from the
mother and ordering medical procedures against her will, Doctor Ivanov disregarded the principle of patient
autonomy and imposed his decisions on the mother and child.
3. **Capability of Doctors:**
- Not every doctor is capable of such an act. While healthcare providers may encounter situations where they
need to make urgent decisions to save a patient's life, the use of force and violation of patient autonomy should be
avoided whenever possible. Doctors are trained to prioritize patient well-being and act ethically and
compassionately in challenging situations. However, individual characteristics, values, and experiences may
influence how healthcare providers respond to emergencies.
4. **Ethics in Medicine:**
- Ethics in medicine encompasses principles such as respect for autonomy, beneficence, non-maleficence, and
justice. Healthcare providers are expected to uphold these ethical principles in their interactions with patients,
ensuring that medical decisions are made collaboratively, with consideration for patient preferences, rights, and
dignity. Violations of ethical principles, such as the use of force against patients or disregard for their autonomy,
can lead to adverse outcomes and undermine trust in the healthcare system.
5. **Legal Responsibility for Communicative Incompetence:**

- Doctors have a legal responsibility to communicate effectively and respectfully with patients and their families.
Failure to obtain informed consent or to address patient concerns and preferences can lead to legal consequences,
including patient complaints, medical malpractice claims, and disciplinary actions. Communicative incompetence,
such as using forceful or coercive tactics to override patient autonomy, may result in legal liability and disciplinary
measures against the healthcare provider.


1.Task:
Nothing ennobles a person more than keeping a secret. This gives a person’s entire life a special meaning. This
frees him from a vain attitude towards the world around him; his secret is his blessing, even if the secret is very
painful. (Kierkegaard S.)
Questions:
1. Is it possible to agree with the philosopher that mystery gives life “special meaning”?
2. What legal documents protect the “painful” secrets of Russian citizens and patients?
3. Have there been any cases of abolition of medical secrets in the history of Russian medicine?
4. Communicating sad news to the patient, his family or relatives of the patient
5. Iatrogenesis, medical errors. Ways to reduce them.
1. **Agreeing with Kierkegaard:**

- While Kierkegaard's perspective suggests that keeping a secret can add depth and meaning to one's life, it's
subjective and depends on individual values and circumstances. Some may find solace or empowerment in privacy,
especially regarding sensitive or painful matters. However, excessive secrecy can also lead to isolation or hinder
emotional healing if it prevents individuals from seeking support or addressing issues openly.
2. **Legal Protection of Secrets:**

- In Russia, the protection of personal and medical information is safeguarded by laws such as the Federal Law on
Personal Data and the Code of Medical Ethics. These laws regulate the collection, storage, and processing of
personal data, including medical records. Patients have the right to confidentiality, and healthcare providers are
obligated to maintain the privacy of their medical information.
3. **Abolition of Medical Secrets:**

- There haven't been cases of outright abolition of medical secrets in Russian medicine. However, there have been
discussions and changes aimed at balancing patient privacy with public health concerns, such as mandatory
reporting of certain infectious diseases to health authorities. Nevertheless, the principle of medical confidentiality
remains fundamental in healthcare practice.
4. **Communicating Sad News:**

- Communicating sad or difficult news to patients, their families, or relatives requires empathy, sensitivity, and
clear communication. Healthcare providers should provide information honestly and compassionately, while also
ensuring that patients and their families understand the situation, prognosis, and available support options. Effective
communication can help alleviate distress and facilitate informed decision-making.
5. **Reducing Iatrogenesis and Medical Errors:**

- To reduce iatrogenesis (harm caused by medical treatment) and medical errors, healthcare systems implement
various strategies, including:
- Establishing robust quality assurance and patient safety protocols.
- Providing ongoing training and education for healthcare professionals on best practices and error prevention.
- Encouraging open communication and reporting of errors to facilitate learning and improvement.
- Implementing technology solutions, such as electronic health records and medication management systems, to
reduce human errors.
- Promoting a culture of transparency, accountability, and continuous improvement within healthcare
organizations.


1.Task:
Doctor Werner tells Pechorin: “she has a wonderful stomach, but her blood is spoiled; there are red spots on the
cheeks . She loves seductive jokes. She told me that her daughter was as innocent as a dove. The princess is being
treated for rheumatism, and God knows what her daughter is suffering from; I ordered both of them to drink two
glasses a day of sour sulfur water .” ( Lermontov M.Yu. “Hero of Our Time”. 1841)
Questions:
2. Did Dr. Werner violate medical confidentiality? Explain.
3. Is everything Werner said about the princess and daughter a medical secret?
4. Incurable patients, the concept of euthanasia, doctor’s tactics
5. Patient satisfaction as the main goal of the doctor’s communicative competence
- Dr. Werner's discussion of the princess's medical condition and treatment plan in a casual manner raises
concerns about patient confidentiality, professionalism, and respect for autonomy. It also touches on the ethical
considerations surrounding the disclosure of sensitive medical information without consent.
2. **Violation of Medical Confidentiality:**

- Yes, Dr. Werner violated medical confidentiality by disclosing details about the princess's medical condition
and treatment to Pechorin without her consent. Patients have a right to privacy regarding their medical information,
and healthcare providers are ethically bound to maintain confidentiality unless authorized by the patient to disclose
such information.
3. **Disclosure of Medical Secrets:**

- While Dr. Werner may not have explicitly revealed the princess's diagnosis, his discussion of her symptoms,
treatment, and family situation breaches the confidentiality of her medical information. Even if he didn't disclose
specific diagnoses, discussing a patient's health in a public or non-clinical setting without consent is inappropriate
and violates medical ethics.
4. **Incurable Patients and Euthanasia:**

- Dr. Werner's comments may reflect a pessimistic view of the princess's health condition, which raises broader
ethical questions about the treatment of incurable patients and the concept of euthanasia. However, Dr. Werner's
approach lacks sensitivity and respect for the princess's dignity and autonomy, and his comments do not suggest
any consideration of euthanasia.
5. **Patient Satisfaction and Communicative Competence:**

- Dr. Werner's manner of discussing the princess's health with Pechorin disregards patient satisfaction and
highlights a lack of communicative competence. Effective communication in healthcare involves respecting patient
confidentiality, maintaining professionalism, and fostering trust and rapport with patients. Dr. Werner's behavior
undermines these principles and may lead to decreased patient satisfaction and trust in healthcare providers.


1.Task :
A 53-year-old woman suffers from alcoholism and cirrhosis of the liver, with varicose veins of the esophagus,
causing recurrent bleeding and requiring large amounts of blood transfusion each time. The patient refuses to stop
drinking alcohol, which would stop or reduce the bleeding. The position of doctors: to charge society's expenses for
each blood transfusion to the patient's account.
Questions:
1. Identify the bioethical problem facing doctors?
2. Would it be fair and ethical to treat such a patient at her own expense? Explain
3. Communication skills required during the initial conversation with the patient.
4. Communication with patients and relatives under conditions potentially traumatic
situations.
5. Conflict-free business communication.
- The bioethical problem facing doctors in this scenario revolves around the allocation of healthcare resources,
patient autonomy, and responsibility for one's health choices. The patient's continued alcoholism exacerbates her
medical condition, leading to recurrent bleeding episodes requiring significant medical intervention and blood
transfusions.
2. **Fairness and Ethical Treatment:**

- Treating the patient at her own expense may be viewed as fair and ethical from the perspective of personal
responsibility and resource allocation. By refusing to stop drinking alcohol despite being aware of the
consequences, the patient contributes to her medical condition and the need for costly interventions. Charging
society's expenses to the patient's account aligns with principles of accountability and fairness, as it reflects the
direct consequences of her actions.
3. **Communication Skills for Initial Conversation:**

- During the initial conversation with the patient, doctors should employ empathetic and non-judgmental
communication techniques to establish rapport and trust. They should express genuine concern for the patient's
well-being while also clearly outlining the risks associated with her continued alcohol consumption. Using open-
ended questions, active listening, and providing information in a clear and understandable manner can facilitate
effective communication and encourage the patient to consider treatment options.
4. **Communication with Patients and Relatives in Traumatic Situations:**

- In situations involving potentially traumatic events, such as recurrent bleeding episodes and the need for blood
transfusions, communication with both the patient and their relatives should be conducted with sensitivity and
compassion. Doctors should provide clear explanations of the situation, treatment options, and potential outcomes
while addressing any concerns or fears expressed by the patient and their family members. Offering emotional
support, reassurance, and involving the patient and their family in decision-making can help alleviate anxiety and
promote trust in the healthcare team.
5. **Conflict-Free Business Communication:**

- While discussing the financial aspects of healthcare with the patient, doctors should approach the conversation
with professionalism and sensitivity. They should explain the rationale behind charging society's expenses to the
patient's account in a clear and non-confrontational manner, emphasizing the need for responsible healthcare
resource allocation. Additionally, doctors should be prepared to address any concerns or objections raised by the
patient regarding the financial implications of their medical care, seeking to find common ground and foster mutual
understanding.

1.Task:
A man, waiting for his turn to see a doctor at the clinic, noticed that the doctor periodically brings patients into the
office without a queue. The indignant patient went up to the chief doctor’s office and expressed his dissatisfaction
with the current situation. The chief physician explained that the clinic can provide paid medical services and that
paid patients are admitted on a first-come, first-served basis. Without waiting his turn, the man was forced to seek
help from another medical institution, and sent a complaint to the administration.
Questions :
1. Are there any violations in the organization of the clinic’s work, your answer ?
2. Does the manager violate the ethical and deontological principles of medicine?
3. Your tactics.
4. Incurable patients, the concept of euthanasia, doctor’s tactics
5. Patient satisfaction as the main goal of the doctor’s communicative competence
1. **Violations in Clinic's Organization:**

- Yes, there are violations in the organization of the clinic's work. By admitting patients without following the
queue system, the clinic is prioritizing paid patients over those waiting in line, which undermines the fairness and
equity of healthcare access. Additionally, this practice may lead to dissatisfaction among patients who have been
waiting for their turn and can erode trust in the clinic's integrity and impartiality.
2. **Ethical Violations by Manager:**

- Yes, the manager is violating ethical and deontological principles of medicine by prioritizing paid patients over
others based on their ability to pay rather than medical need or order of arrival. This practice goes against the
principles of justice, beneficence, and non-maleficence, which require healthcare professionals to prioritize patients'
well-being and provide care based on medical necessity rather than financial status.
3. **Tactics:**
- In this situation, it's important for the patient to express their concerns and dissatisfaction with the clinic's
practice in a calm and respectful manner. They should seek clarification from the chief physician regarding the
clinic's policy on admitting patients and advocate for fair and equitable access to healthcare for all patients,
regardless of their ability to pay. If the response from the chief physician is unsatisfactory, the patient may consider
escalating the issue to higher authorities or seeking care from another medical institution where queue systems are
adhered to more strictly.
4. **Incurable Patients and Euthanasia:**

- While the concept of euthanasia may be relevant in cases of incurable patients suffering from terminal illnesses,
it is not directly applicable to the situation described. However, the principle of patient autonomy and the ethical
obligation to provide compassionate end-of-life care remain important considerations in medical practice.
5. **Patient Satisfaction and Communicative Competence:**

- Patient satisfaction should indeed be a primary goal of the doctor's communicative competence. Effective
communication involves listening to patient concerns, addressing their needs and preferences, providing clear
information about treatment options, and fostering a trusting and collaborative relationship between the doctor and
patient. By prioritizing patient satisfaction, doctors can enhance the overall quality of care and improve patient
outcomes.


1.Task:
A 30-year-old girl filed a complaint with the head of the surgical department where her mother was being treated.
The woman underwent surgery, after which she was strictly prohibited from eating for 2 days without warning her
about it. In response to the girl’s comments, the ward nurse became rude , saying that she was not obligated to
follow this. Communication in a broad sense is the exchange of information between individuals through a common
system of symbols. Communication with everyone involved in palliative care is fundamental to improving all
aspects of a patient's quality of life.
Questions :
1. By what means can communication be carried out with the patient and his close circle?
2. What are the different approaches to communication?
3. Which of the approaches involves the joint activity of communication participants, during which a common (to a
certain limit) view of things is developed?
4. Moral qualities of a doctor.
5. Duty and ethics of a doctor
1. Communication with the Patient and Close Circle:

- Communication with the patient and their close circle can be carried out through various means, including
verbal communication during face-to-face interactions, written communication through medical records or
informational pamphlets, digital communication via email or telemedicine platforms, and non-verbal
communication such as body language and facial expressions. Additionally, involving interpreters or translators
when language barriers exist can facilitate effective communication with patients from diverse backgrounds.
2. Different Approaches to Communication:

- There are several approaches to communication in healthcare, including:
- Patient-Centered Communication: Focuses on understanding and addressing the patient's needs, preferences,
and concerns, and involving them in decision-making regarding their care.
- Empathetic Communication: Demonstrates understanding, compassion, and empathy towards the patient's
emotions and experiences.
- Clear and Transparent Communication: Involves providing accurate and understandable information to patients
and their families about their condition, treatment options, and prognosis.
- Collaborative Communication: Encourages collaboration and teamwork among healthcare providers, patients,
and their families to achieve shared treatment goals and ensure continuity of care.
- Culturally Competent Communication: Recognizes and respects cultural differences and tailors communication
approaches to meet the cultural needs and preferences of patients and their families.
3. Joint Activity of Communication Participants:

- The approach that involves joint activity and the development of a common view of things is collaborative
communication. In collaborative communication, healthcare providers, patients, and their families work together as
partners to share information, discuss treatment options, and make decisions that align with the patient's values and
goals. This approach promotes shared decision-making and fosters a sense of partnership and trust between
healthcare providers and patients.
4. Moral Qualities of a Doctor:

- Moral qualities of a doctor include integrity, compassion, empathy, honesty, professionalism, respect for patient
autonomy, and a commitment to ethical principles. These qualities guide doctors in providing compassionate and
patient-centered care, upholding ethical standards, and maintaining trust and confidence in the doctor-patient
relationship.
5. Duty and Ethics of a Doctor:

- The duty of a doctor is to prioritize the well-being and best interests of their patients, uphold ethical principles,
and provide competent and compassionate care. Ethical responsibilities include respecting patient autonomy,
beneficence (doing good), non-maleficence (avoiding harm), and justice in the allocation of healthcare resources.
Doctors are also obligated to maintain confidentiality, obtain informed consent, and adhere to professional
standards and codes of conduct in their practice.

1.Task:
At the reception there is a 39-year-old woman, a teacher at school. Married for 13 years, no children.
The examination shows several years of infertile marriage. The patient and her husband, a construction worker and
handyman, face a lengthy and expensive examination; there is no guarantee of pregnancy. You have to inform the
patient about her condition, prognosis, and provide support in her further actions.
Questions :
2. What are the different approaches to communication?3. Which of the approaches involves the joint activity of
communication participants, during which a common (to a certain limit) view of things is developed?
4. Define the terms Verbal and non-verbal methods of communication ? .
5.What is the Mechanistic and activity method of communication
1. Communication with the patient and her close circle can be carried out through various means, including:
- Face-to-face consultations with the patient and her husband to discuss the diagnosis, prognosis, and treatment
options.
- Providing informational brochures, pamphlets, or educational materials about infertility, treatment options, and
support resources.
- Utilizing telemedicine platforms for remote consultations, especially for follow-up discussions or counseling
sessions.
- Referring the patient and her husband to support groups or counseling services specializing in infertility and
reproductive health.
2. Different approaches to communication include:

- Directive Approach: Providing clear and specific information about the diagnosis, prognosis, and treatment
options, and offering guidance on decision-making.
- Collaborative Approach: Engaging the patient and her husband as active participants in the communication
process, encouraging shared decision-making, and considering their preferences and values.
- Supportive Approach: Offering empathy, emotional support, and reassurance to the patient and her husband,
acknowledging the challenges they face and validating their feelings and concerns.
3. The collaborative approach involves the joint activity of communication participants, during which a common
view of things is developed to a certain extent. In this approach, the healthcare provider and the patient and her
husband work together to understand the diagnosis, explore treatment options, and make decisions that align with
their goals and values.
4. Verbal methods of communication involve the use of spoken language to convey information, express thoughts
and emotions, and engage in conversation. Non-verbal methods of communication include gestures, facial
expressions, body language, tone of voice, and other forms of communication that do not involve words but convey
meaning and emotions.
5. Mechanistic method of communication focuses on conveying information in a straightforward and linear manner,
often prioritizing the transmission of facts and data. Activity method of communication involves engaging
participants in interactive and participatory communication processes, encouraging collaboration, exploration, and
co-creation of meaning through dialogue and shared experiences.


1.Task:
At the appointment, a 21-year-old guy learned that the test result for HIV was positive . HIV / AIDS , requiring
palliative medical care, can last indefinitely and lead not only to intense changes in the psychological state, but also
to the emergence of severe mental disorders requiring specialized psychiatric care. HIV/AIDS is a disease that
causes intense chronic stress, manifested by a variety of emotional responses.
Questions:
1) What emotional responses manifest chronic stress in patients with HIV/ AIDS ?
2) What are the main aspects of unresolved problems that are factors that traumatize the psyche of patients with
HIV/ AIDS ?
3) What medical problems affect the quality of life of patients with HIV/ AIDS ?
4) What psychological aspects worry patients with HIV/ AIDS most of all ?
5) What are the most common social problems of patients with HIV/ AIDS in connection with impending death that
increase the social isolation of the patient and his family members and aggravate family problems?
1) Emotional responses manifesting chronic stress in patients with HIV/AIDS include:

- Anxiety: Persistent worry and apprehension about the future, health, and stigma associated with HIV/AIDS.
- Depression: Feelings of sadness, hopelessness, and loss of interest in activities previously enjoyed.
- Fear: Fear of the progression of the disease, fear of death, and fear of social stigma and discrimination.
- Anger: Frustration and anger about the diagnosis, perceived injustices, and challenges in accessing healthcare
and support.
- Guilt and Shame: Feelings of guilt or shame related to the perceived cause of HIV infection, such as unprotected
sex or drug use.
2) Main aspects of unresolved problems traumatizing the psyche of patients with HIV/AIDS include:
- Stigma and Discrimination: Fear of rejection, discrimination, and social isolation due to HIV/AIDS status.
- Grief and Loss: Coping with the loss of health, relationships, and life opportunities due to the diagnosis.
- Uncertainty: Dealing with the unpredictable nature of the disease, including fluctuating health status and
uncertain prognosis.
- Disclosure and Secrecy: Challenges in disclosing HIV status to others and concerns about confidentiality and
privacy.
- Coping with Chronic Illness: Managing the physical symptoms, treatment side effects, and the need for ongoing
medical care.
3) Medical problems affecting the quality of life of patients with HIV/AIDS include:
- Opportunistic Infections: Increased susceptibility to infections due to weakened immune function.
- Antiretroviral Therapy Side Effects: Adverse effects of antiretroviral medications, such as nausea, fatigue, and
metabolic changes.
- Chronic Health Conditions: Long-term complications of HIV/AIDS, including cardiovascular disease,
neurocognitive disorders, and malignancies.
- Mental Health Disorders: Co-occurring mental health conditions such as depression, anxiety, and substance use
disorders.
4) Psychological aspects most worrying patients with HIV/AIDS include:

- Fear of Death: Anxiety and distress about the progression of the disease and mortality.
- Coping with Uncertainty: Difficulty coping with the unpredictable course of the illness and future health
outcomes.
- Emotional Distress: Managing feelings of sadness, hopelessness, and despair associated with living with a
chronic, life-threatening illness.
- Loss of Identity: Struggles with maintaining a sense of self and identity in the face of HIV/AIDS-related stigma
and discrimination.
5) Common social problems of patients with HIV/AIDS in connection with impending death that increase social
isolation and aggravate family problems include:
- Social Stigma and Discrimination: Fear of rejection and discrimination from friends, family, and the broader
community due to HIV/AIDS status.
- Lack of Social Support: Limited social support networks and isolation due to fear of disclosure or actual
rejection.
- Financial Hardship: Economic challenges related to the cost of medical care, medications, and loss of
employment due to illness.
- Relationship Strain: Struggles in intimate relationships and family dynamics due to fear, stigma, and
communication barriers related to HIV/AIDS.
- End-of-Life Care Issues: Concerns about access to palliative care, hospice services, and support for end-of-life
decision-making and planning.


A man came to the appointment with acute pain and was not booked in. The patients in line began to complain and
swear at the man in a high-pitched voice. With the words - we need to sign up, so what if we expect acute pain in
the morning. Communication in a broad sense is the exchange of information between individuals through a
common system of symbols. Communication with everyone involved in palliative care is fundamental to improving
all aspects of a patient's quality of life.
Questions :
2. What are the different approaches to communication?3. Which of the approaches involves the joint activity of
communication participants, during which a common (to a certain limit) view of things is developed?
4. The authority of the doctor , give an explanation.
5. The concept of medical deontology.
1. Means of Communication with the Patient and Close Circle:

- Direct verbal communication: Speaking directly to the patient and their close circle to address concerns and
provide information.
- Written communication: Providing written instructions or educational materials to the patient and their family to
supplement verbal communication.
- Non-verbal communication: Using body language, facial expressions, and gestures to convey empathy,
understanding, and support.
- Electronic communication: Utilizing email, text messaging, or telecommunication platforms to communicate
with patients and their families, especially in situations where face-to-face interaction is not possible.
2. Different Approaches to Communication:

- Direct communication: Clear and straightforward communication to convey information and address concerns.
- Empathetic communication: Showing empathy and understanding towards the patient's feelings and
experiences.
- Collaborative communication: Involving the patient and their close circle in decision-making and care planning.
- Culturally sensitive communication: Adapting communication styles and approaches to align with the patient's
cultural background and preferences.
3. Joint Activity Approach to Communication:

- Collaborative communication involves joint activity, where both the healthcare provider and the patient (and
their close circle) actively participate in the communication process.
- This approach aims to establish a partnership between the healthcare provider and the patient, fostering shared
decision-making and mutual understanding.
- Through collaborative communication, a common understanding of the patient's condition, treatment options,
and goals of care can be developed, allowing for more patient-centered and effective care delivery.
4. Authority of the Doctor:

- The authority of the doctor refers to the trust, expertise, and professional knowledge that patients and their
families attribute to healthcare providers.
- It involves respecting the doctor's medical expertise while also recognizing the importance of patient autonomy
and shared decision-making.
- Doctors should use their authority responsibly, prioritizing the well-being and preferences of the patient while
providing evidence-based care and guidance.
5. Concept of Medical Deontology:

- Medical deontology refers to the ethical principles and duties that guide the behavior and decision-making of
healthcare professionals.
- It includes principles such as beneficence (doing good), non-maleficence (avoiding harm), justice (fairness), and
respect for patient autonomy.
- Medical deontology emphasizes the importance of upholding ethical standards, maintaining patient
confidentiality, obtaining informed consent, and prioritizing the well-being of patients in medical practice.


1.Task:
A 16-year-old girl turned to the antenatal clinic at her place of residence with a request to terminate her pregnancy.
The doctor, having learned the patient’s age, began to be indignant: “ This didn’t happen in our time ! Don't you
have a head on your shoulders? You need to think about the consequences. I guess I’ll have to tell my parents.” The
girl considered the doctor’s behavior unethical and wrote a complaint to the administration.
Questions:
2. Is this a violation of ethical and deontological rules in medicine ?
4. Conflict-free business communication.
5. How do you understand the concept : Ethics in medicine
1. Doctor's Competence: The doctor's response demonstrates a lack of professionalism and sensitivity to the
patient's needs. Rather than providing support and guidance, the doctor reacted with indignation and judgment,
which is not conducive to effective patient care.
2. Violation of Ethical and Deontological Rules: Yes, this is a clear violation of ethical and deontological rules in
medicine. The doctor breached the principles of beneficence, non-maleficence, and respect for patient autonomy.
By reacting negatively and threatening to disclose the patient's confidential information without her consent, the
doctor failed to prioritize the patient's well-being and violated her right to privacy.
3. Communication with Patients with Cultural and Linguistic Differences:

- Understanding cultural and linguistic differences is crucial in effective communication with patients.
- It's important to approach each patient with cultural humility, recognizing and respecting their values, beliefs,
and preferences.
- Using interpreters or language services when necessary can help bridge communication gaps and ensure mutual
understanding.
- Sensitivity to cultural norms and taboos is essential to avoid misunderstandings and build trust with patients
from diverse backgrounds.
4. Conflict-Free Business Communication:

- Conflict-free business communication involves respectful and professional interaction, even in challenging
situations.
- Active listening, empathy, and understanding are key to resolving conflicts and addressing concerns.
- Maintaining professionalism and focusing on finding mutually beneficial solutions can help prevent conflicts
from escalating.
5. Ethics in Medicine:
- Ethics in medicine encompasses principles and values that guide the conduct of healthcare professionals in their
interactions with patients, colleagues, and society.
- It involves upholding principles such as beneficence (doing good), non-maleficence (avoiding harm), justice
(fairness), and respect for autonomy (respecting patients' rights to make their own decisions).
- Ethics in medicine also includes maintaining patient confidentiality, obtaining informed consent, and adhering
to professional standards and guidelines to ensure the highest standard of care for patients.

1.Task.
Student P., who had previously been treated for symptoms of violence and paranoid ideas, told the therapist that he
intended to kill the student. He did not give her name, but based on the information he provided, she could be
identified as T. Campus police were notified, but T's family was not notified. P. was detained by campus police and
later released because the police believed he was sane. T. returned after the holidays, and P. killed her. T's family
sued the university and the therapists for failing to take appropriate steps, which T's parents argue should have
included warning them of the danger their daughter faced. The court granted the claim
Questions:
1. What principle of bioethics is at the center of this situation?
2. What ethical controversy was the court's decision supposed to resolve?
3. What are the specifics of the work of a psychiatrist as opposed to a somatic doctor?
4.What is the communicative competence of a doctor and its psychological characteristics?
5. What methods of communication with the patient exist.
1. Principle of Beneficence: This situation raises questions about the duty of healthcare professionals to act in the
best interest of their patients. It involves balancing the duty to maintain patient confidentiality with the
responsibility to prevent harm to others.
2. Ethical Controversy: The court's decision aimed to resolve the conflict between the duty to maintain patient
confidentiality and the duty to protect potential victims from harm. It addressed the question of whether healthcare
professionals have a legal and ethical obligation to warn potential victims when a patient poses a credible threat to
their safety.
3. Specifics of Psychiatry vs. Somatic Medicine:

- Psychiatry focuses on diagnosing, treating, and preventing mental disorders, including assessment of risk factors
for violence.
- Psychiatrists are trained to evaluate patients' mental state, including the presence of psychotic symptoms, violent
tendencies, or risk of harm to self or others.
- Somatic doctors, on the other hand, primarily deal with physical ailments and may not have the same training or
expertise in assessing and managing psychiatric conditions.
4. Communicative Competence of a Doctor:

- Communicative competence involves the ability to effectively convey information, build rapport, and establish
trust with patients.
- Psychological characteristics such as empathy, active listening, cultural sensitivity, and nonverbal
communication skills are essential for effective doctor-patient communication.
- In this situation, the psychiatrist's communicative competence would include the ability to assess and respond to
the patient's statements about violent intentions while maintaining confidentiality and adhering to legal and ethical
obligations.
5. Methods of Communication with Patients:

- Verbal Communication: Direct conversation, providing information, explaining diagnosis and treatment options.
- Nonverbal Communication: Body language, facial expressions, gestures, which can convey empathy,
reassurance, and understanding.
- Written Communication: Providing written materials, such as brochures or handouts, to supplement verbal
explanations.
- Active Listening: Paying attention to the patient's concerns, asking clarifying questions, and demonstrating
understanding.
- Empathetic Communication: Expressing empathy and understanding towards the patient's emotions and
experiences.
- Collaborative Communication: Involving the patient in decision-making, respecting their autonomy, and
fostering a partnership in healthcare.


1.Task. A medical college student entered the room after a long absence, said hello, looked around and exclaimed:
“How are you still alive?!” The exclamation was addressed to a seriously ill patient in the ward.
Questions:
1. What consequences may occur for the patient after such a “surprise”?
2. Evaluate the student’s behavior towards a seriously ill patient.
3 Your tactics in this situation.
4.Types of attitude towards illness
5. Psychological reactions of patients to the disease
1. Consequences for the Patient:

- Such a remark can induce fear, anxiety, or distress in the patient, exacerbating their emotional and psychological
state.
- The patient may feel offended, humiliated, or belittled, impacting their trust in the medical staff and their overall
well-being.
2. Evaluation of the Student's Behavior:

- The student's behavior was highly inappropriate, lacking sensitivity, empathy, and professionalism.
- Making such a comment to a seriously ill patient demonstrates a lack of understanding of the patient's condition
and the gravity of their situation.
- It can be perceived as disrespectful and insensitive, potentially causing harm to the patient's emotional and
psychological state.
3. Recommended Tactics:
- The student should immediately apologize to the patient for the inappropriate remark and acknowledge the
impact it may have had on them.
- Offer reassurance to the patient and demonstrate genuine concern for their well-being.
- Engage in respectful and supportive communication with the patient, focusing on their needs and comfort.
4. Types of Attitude Towards Illness:

- Attitudes towards illness can vary widely among individuals and are influenced by cultural, social, and personal
factors.
- Some people may adopt a stoic attitude, accepting their illness and focusing on treatment and recovery.
- Others may experience fear, anxiety, or denial, struggling to come to terms with their condition.
- Attitudes can also be influenced by past experiences, beliefs, and support systems.
5. Psychological Reactions of Patients to Disease:

- Patients may experience a range of psychological reactions to illness, including anxiety, depression, fear, anger,
and grief.
- The impact of illness on mental health can vary depending on factors such as the severity of the condition,
prognosis, coping mechanisms, and social support.
- Patients may also experience adjustment difficulties, changes in self-esteem, and disruptions in their daily
functioning.
- Psychological support, empathy, and effective communication from healthcare providers are crucial in
addressing and alleviating patients' emotional distress.


1.Task.
A patient who had an appointment with a doctor walked into the office where the nurse was. The nurse responds to
the question “Where is the doctor?” answered that the patient should close the door on the other side, and learned to
read the notices on the doors. The woman was outraged by the rude answer. Having found out that the doctor was
ill, and for the sake of the appointment she took time off from work, she told the nurse about this. To which she
said that it was her problem. The patient called the hotline with a complaint and asked to deal with the rude
behavior of the medical staff.
Questions :
1. Do the professional responsibilities of a nurse include assisting the doctor in organizing patients’ appointments?
2. What kind of violation is this?
3.What is the patient’s psychology, the characteristics of his psyche.
4. What should be taken into account in a doctor’s behavior with a conflict patient?
5. Communication with patients with mental disorders.
1. Professional Responsibilities of a Nurse:

- While assisting the doctor in organizing patients' appointments may fall within the scope of a nurse's duties in
some healthcare settings, it's not a universal obligation. However, providing courteous and helpful assistance to
patients seeking information or guidance is generally expected of healthcare professionals, including nurses.
2. Violation Assessment:
- The nurse's rude response to the patient's inquiry constitutes a violation of professional conduct and patient-
centered care. Healthcare professionals are expected to communicate with patients respectfully and empathetically,
addressing their concerns and needs.
3. Patient Psychology:
- The patient likely experienced feelings of frustration, indignation, and possibly humiliation due to the nurse's
dismissive and disrespectful behavior.
- The patient may also feel disempowered and disregarded, as her legitimate inquiry was met with rudeness and
indifference.
4. Doctor's Behavior with a Conflict Patient:

- When dealing with a conflict patient, the doctor should remain calm, empathetic, and professional.
- Active listening is essential to understand the patient's concerns and address them appropriately.
- The doctor should validate the patient's feelings, apologize for any inconvenience or misunderstanding, and take
steps to resolve the conflict constructively.
- It's crucial for the doctor to maintain professionalism and avoid escalating the situation further.
5. Communication with Patients with Mental Disorders:

- Communication with patients with mental disorders requires sensitivity, patience, and understanding.
- Healthcare professionals should adapt their communication style to accommodate the patient's specific needs
and abilities.
- Establishing trust and rapport is essential for effective communication and building a therapeutic relationship.
- Clear, concise, and straightforward communication is preferred, avoiding jargon and complex language.
- Collaborating with mental health professionals and involving the patient's support network can enhance
communication and treatment outcomes.


1.Task.
The man came to the reception. The doctor ordered examinations for him. He said that he had done these
examinations recently as part of a medical examination and would not undergo them again. He was sent for the
results. The health center's paramedic refused to give him the results. The patient has returned. The doctor wrote
him a note for the paramedic asking him to give the results to the patient. The paramedic said that there were no
ECG and CBC results for this patient’s blood, and that he should go to the prevention department for the results,
and not to the health center. The man returned upset, his blood pressure increased to 180/100 mmHg. The
hypertensive crisis was complicated by a heart attack.
Exercise:
1. Evaluate the doctor’s actions?
2. Is this a violation?
3.Skills for effective and conflict-free communication with patients, relatives of patients and colleagues.
4. Barriers and solutions to problems that prevent effective communication between doctor and patient
5. The importance of communicative competence for effective and conflict-free interaction between a doctor and a
patient, his family members, and colleagues
1. Evaluation of the Doctor's Actions:
- The doctor's actions in ordering examinations for the patient were appropriate based on the patient's presenting
symptoms and medical history.
- However, the failure to provide the patient with the results in a timely manner, as well as the lack of
coordination between the doctor and paramedic regarding the availability of results, reflects a breakdown in
communication and follow-up.
2. Violation Assessment:
- There is a violation of proper patient care and communication protocols in this scenario.
- The paramedic's refusal to provide the patient with his test results and directing him to another department
without proper explanation or coordination constitutes a violation of the patient's rights to access their medical
information and receive appropriate care.
3. Skills for Effective Communication:

- Active listening: The doctor and paramedic should have listened to the patient's concerns and addressed them
promptly and effectively.
- Empathy: Understanding the patient's frustration and anxiety can help healthcare professionals communicate
more empathetically and provide appropriate support.
- Clear and transparent communication: Healthcare professionals should communicate clearly with patients,
relatives, and colleagues, ensuring that information is conveyed accurately and comprehensively.
4. Barriers and Solutions to Effective Communication:

- Barriers: Lack of coordination between healthcare professionals, inadequate communication channels,
bureaucratic hurdles in accessing medical information.
- Solutions: Implementing clear protocols for communication and information sharing among healthcare team
members, establishing efficient systems for retrieving and sharing patient information, improving staff training on
effective communication strategies.
5. Importance of Communicative Competence:

- Effective communication is crucial for building trust, ensuring patient safety, and delivering high-quality care.
- Communicative competence enables healthcare professionals to establish rapport with patients, address their
concerns, and involve them in decision-making about their care.
- In this scenario, better communication between the doctor, paramedic, and patient could have prevented
misunderstandings, reduced patient anxiety, and facilitated appropriate care delivery.


1.Task.
Patient K., 80 years old, was admitted to the emergency department with stroke. The patient's condition is serious.
But admission to the intensive care unit was denied. The patient's relatives were very indignant and demanded an
explanation from the doctor on duty. He motivated his decision by the fact that he did not want to waste his time in
vain, since the patient is elderly and the prognosis of his disease is poor, and at any moment a young patient who is
more likely to have a favorable outcome can be admitted.
Questions:
2. Is this a violation of ethical and deontological rules in medicine?
4. Features of communication with patients with visual impairments,
5. Features of communication with patients with speech disorders.
1. Assessing the Doctor’s Competence:

- The doctor's decision to deny admission to the intensive care unit based solely on the patient's age and perceived
poor prognosis raises concerns about the doctor's competence.
- Competent medical decision-making should be based on clinical assessment, patient needs, and evidence-based
guidelines rather than arbitrary factors such as age.
- The doctor's duty is to provide appropriate medical care and treatment based on the individual needs and
condition of each patient, regardless of age.
2. Violation of Ethical and Deontological Rules:

- Yes, this decision may constitute a violation of ethical and deontological rules in medicine.
- Denying intensive care solely based on age and prognosis without considering the patient's individual
circumstances, wishes, and potential for recovery violates principles such as beneficence, non-maleficence, and
respect for patient autonomy.
- It goes against the ethical duty of doctors to prioritize patient welfare and provide equitable access to medical
care without discrimination.
3. Communication with Patients with Cultural and Linguistic Differences:

- Communication with patients who have cultural and linguistic differences requires sensitivity, empathy, and
effective communication strategies.
- Doctors should strive to understand and respect the cultural beliefs, values, and preferences of patients and their
families.
- Using interpreters or language assistance services can facilitate communication and ensure that patients
understand their condition, treatment options, and care plan.
- Taking the time to listen actively, clarify information, and address concerns in a culturally sensitive manner can
enhance trust and rapport with patients from diverse backgrounds.
4. Communication with Patients with Visual Impairments:

- When communicating with patients with visual impairments, doctors should provide information verbally and in
alternative formats such as braille, large print, or audio recordings.
- Using descriptive language to explain procedures, treatment options, and medical instructions can help patients
with visual impairments understand their healthcare needs.
- Doctors should also be mindful of non-verbal communication cues and ensure that the physical environment is
conducive to navigation and accessibility for patients with visual impairments.
5. Communication with Patients with Speech Disorders:

- When communicating with patients with speech disorders, doctors should demonstrate patience, attentiveness,
and understanding.
- Using alternative communication methods such as written notes, gestures, or communication boards can
facilitate understanding and enable patients to express their needs and concerns.
- Doctors should also collaborate with speech therapists or other specialists to develop individualized
communication strategies that accommodate the patient's specific speech disorder and communication abilities.

1.Task.
The doctor prescribed the patient Z. diphenhydramine . Soon after using the drug, it turned out that the patient had
developed a spasm of the respiratory tract. When checking, it turned out that the doctor did not indicate the required
dosage of the drug in the prescription. Due to the complication, the victim wrote a complaint that the doctor was
negligent about her health and demanded compensation for material damage.
Questions:
1. Doctor's mistakes
2. Is the patient’s complaint justified?
3. How could this situation have been avoided ?
4. Communicative and ethical problems of dying, resuscitation and death
5. Achieving initial mutual understanding.
1. Doctor's Mistakes:
- The doctor's mistake was prescribing diphenhydramine without specifying the dosage on the prescription, which
led to the patient experiencing a respiratory tract spasm as a complication.
2. Justification of Patient's Complaint:

- The patient's complaint is justified because the doctor's negligence in not specifying the dosage on the
prescription resulted in harm to the patient's health.
- The patient suffered a complication due to the lack of clear instructions on the medication, which could have
been avoided with proper prescribing practices.
3. Avoiding the Situation:

- The situation could have been avoided if the doctor had followed proper prescribing protocols and included the
necessary dosage information on the prescription.
- Before prescribing medication, the doctor should have verified the appropriate dosage for the patient based on
factors such as age, weight, medical history, and other medications being taken.
- Double-checking prescriptions for accuracy and completeness can help prevent errors and ensure patient safety.
4. Communicative and Ethical Problems of Dying, Resuscitation, and Death:

- While not directly related to the situation described, issues related to dying, resuscitation, and death involve
complex ethical and communicative considerations.
- Communicating with patients and their families about end-of-life care decisions, resuscitation preferences, and
coping with grief and loss requires sensitivity, empathy, and clear communication.
- Ethical dilemmas may arise in situations involving end-of-life care, such as respecting patients' autonomy and
quality of life while balancing beneficence and non-maleficence.
5. Achieving Initial Mutual Understanding:

- Achieving initial mutual understanding between the doctor and patient involves effective communication, active
listening, and shared decision-making.
- The doctor should ensure that the patient understands the purpose, risks, and potential side effects of prescribed
medications.
- Encouraging the patient to ask questions and express any concerns or preferences can help establish mutual
understanding and foster a collaborative doctor-patient relationship.
- Providing clear instructions and information about medications, including dosage, administration, and potential
adverse effects, can empower patients to take an active role in their healthcare and prevent misunderstandings or
complications.

1.Task.
A 45-year-old patient has been undergoing treatment in the cardiology department for a month . He very much
doubts all the procedures that are performed on him as prescribed by the doctor, and does not believe in the success
of the treatment. During procedures, he argues with the nurse, often has a smirk on his face, and may not show up
for scheduled tests. The nurse tried to talk to the patient, but he does not listen to her, is rude, and hides his eyes.
The nurse managed to find out during the conversation that the patient had a negative experience with the medical
staff.
Questions:
1.Tactics of the Doctor
2.What effect of communication did the patient receive, how to fix it.
3.What is the impetus for the conflict to occur?
4. Strategies for behavior in a conflict situation.
5. Personality questionnaires , clinical standardized scale assessment methods
and self-assessment of patients' condition.
1. Doctor's Tactics:
- The doctor should approach the patient with empathy and understanding, acknowledging the patient's concerns
and addressing them with patience and respect.
- Engage in active listening to understand the root causes of the patient's doubts and fears regarding the treatment.
- Provide clear explanations of the treatment plan, procedures, and expected outcomes, addressing any
misconceptions or misinformation the patient may have.
- Collaborate with the patient to develop a trusting doctor-patient relationship based on open communication and
shared decision-making.
2. Communication Effect and Resolution:

- The patient likely received communication characterized by skepticism, disrespect, and frustration, leading to
further distrust and resistance to treatment.
- To address this, the doctor should prioritize building rapport and trust with the patient, demonstrating empathy,
active listening, and understanding.
- Clarify any misunderstandings or misconceptions the patient may have about the treatment plan and address
them with evidence-based information and reassurance.
- Offer support and encouragement, emphasizing the importance of adhering to the treatment plan for the patient's
health and well-being.
3. Impetus for Conflict:

- The conflict likely stems from the patient's negative past experiences with medical staff, leading to mistrust and
skepticism toward the current healthcare team.
- Fear, anxiety, and frustration regarding the treatment process and outcomes may also contribute to the patient's
defensive and resistant behavior.
- Communication barriers, such as misunderstandings or misinterpretations of information, can escalate conflict
and hinder effective doctor-patient interaction.
4. Conflict Resolution Strategies:

- Approach the patient with empathy and patience, acknowledging their concerns and emotions without judgment.
- Use open-ended questions to encourage the patient to express their thoughts and feelings, allowing for a deeper
understanding of their perspective.
- Validate the patient's experiences and emotions, demonstrating empathy and understanding.
- Collaborate with the patient to address their concerns and find mutually acceptable solutions to improve the
doctor-patient relationship and enhance treatment adherence.
5. Assessment Methods:
- Personality questionnaires: Assessing the patient's personality traits and coping mechanisms can provide insight
into their behavior and emotional responses to medical treatment.
- Clinical standardized scale assessment methods: Utilizing standardized scales, such as the Hospital Anxiety and
Depression Scale (HADS) or the Patient Health Questionnaire (PHQ-9), can help assess the patient's mental health
status and identify any underlying anxiety or depression.
- Self-assessment of the patient's condition: Encouraging the patient to self-assess their condition, symptoms, and
treatment adherence can empower them to take an active role in their healthcare and facilitate open communication
with their healthcare team.


1.Task.
A young woman, 32 years old, consulted an obstetrician-gynecologist about pregnancy. From her life history it is
known that she had rubella. This disease in the early stages causes congenital deformities in 60-70% of cases. The
doctor advised the woman to terminate the pregnancy, arguing that she would give birth to a freak . The woman
began to get nervous and her condition worsened sharply.
Questions :
1. Bioethical Problem:
The bioethical problem in this scenario involves communication breakdown and ethical considerations
surrounding reproductive healthcare, particularly in advising a patient about pregnancy termination based on
medical history.
2. Signs of Conflict:
- Emotional Distress: The woman's worsening condition and nervousness indicate emotional distress, which could
be a sign of conflict arising from the doctor's recommendation.
- Disagreement: If the woman disagrees with the doctor's advice to terminate the pregnancy, it can lead to conflict
regarding treatment decisions.
- Miscommunication: If the doctor's advice was not communicated effectively or sensitively, it could contribute
to misunderstandings and conflict.
3. Doctor's Competence:
The doctor's competence is called into question due to the manner in which the recommendation for pregnancy
termination was delivered. While the doctor may have been acting based on medical knowledge and concern for
potential risks to the fetus, the lack of sensitivity and consideration for the patient's emotional well-being may
indicate a lapse in communication skills and ethical judgment.
4. Conflict Resolution Methods:

- Open Communication: The doctor should engage in open and empathetic communication with the patient to
understand her concerns and provide information about the risks and options available.
- Shared Decision-Making: Collaborative decision-making involves discussing treatment options with the patient,
considering her values and preferences, and reaching a mutual agreement that respects her autonomy.
- Mediation: In cases of significant disagreement, involving a neutral third party, such as a counselor or mediator,
can facilitate communication and help find a resolution that meets the needs of both the patient and the healthcare
provider.
- Ethics Consultation: Seeking input from an ethics committee or consultant can provide guidance on navigating
complex ethical dilemmas and ensuring that decisions align with ethical principles and professional standards.
5. Joint Resolution:
- The doctor and patient should engage in a dialogue to address the underlying concerns and fears driving the
patient's emotional distress.
- The doctor should provide clear explanations of the medical rationale behind the recommendation for pregnancy
termination while acknowledging the patient's emotions and concerns.
- Exploring alternative options, such as genetic counseling or prenatal screening, may provide the patient with
additional information and support in making an informed decision about her pregnancy.
- Ultimately, the goal is to reach a resolution that respects the patient's autonomy, ensures her emotional well-
being, and upholds ethical principles of beneficence, non-maleficence, and respect for patient autonomy.


1.Task.
Three years ago, Nikolai underwent surgery for prostate adenoma. The postoperative period was difficult, and six
months later Nikolai developed a stricture (narrowing) of the urinary canal, which required repeat surgery.
The essence of the conflict is this:
- the patient claims that he was not warned about the possible consequences of the operation, otherwise he would
not have agreed to it, and demands compensation for moral damage caused;
— doctors are confident that a conversation with the patient took place before the operation, and do not consider
themselves guilty in this situation.
Questions:
5. Methods for resolving interpersonal conflicts.
The bioethical problem in this scenario revolves around informed consent and the communication of potential
risks and consequences associated with medical procedures. Specifically, the conflict arises from discrepancies
between the patient's recollection of the preoperative conversation and the doctors' assertion that adequate
information was provided.
2. Conflict Origin:
The conflict arises due to discrepancies in communication and understanding between the patient and the medical
team regarding the informed consent process. The patient claims that he was not adequately informed about the
potential consequences of the surgery, leading to feelings of betrayal and a demand for compensation. On the other
hand, the doctors believe that they fulfilled their duty to inform the patient about the risks and benefits of the
procedure, but the patient's perception differs from their understanding.
3. Bioethical Principles:
The principles of autonomy, beneficence, and non-maleficence are relevant in this context:
- Autonomy: Patients have the right to make informed decisions about their healthcare based on accurate and
comprehensive information. If the patient was not adequately informed about the potential consequences of the
surgery, his autonomy may have been compromised.
- Beneficence: Healthcare providers have a duty to act in the best interests of the patient and promote their well-
being. This includes providing patients with the information they need to make informed decisions about their care.
- Non-maleficence: Healthcare providers have a duty to avoid causing harm to patients. If the patient suffered
harm due to inadequate information or understanding of the risks associated with the surgery, this principle may
have been violated.
4. Levels of Communication:
- Interpersonal Communication: This involves communication between the patient and the medical team during
the informed consent process. Characteristics include clarity, transparency, and ensuring mutual understanding of
the information provided.
- Intraprofessional Communication: Communication within the medical team is crucial for ensuring that all
relevant information is conveyed to the patient and that any concerns or questions are addressed effectively.

- Mediation: A neutral third party, such as a mediator or patient advocate, can facilitate communication between
the patient and the medical team to address misunderstandings and find common ground.
- Reconciliation: Both parties can work towards understanding each other's perspectives and finding a resolution
that addresses the patient's concerns while acknowledging the doctors' efforts to provide appropriate care.
- Review of Documentation: Reviewing the consent form and medical records may help clarify what information
was provided to the patient before the surgery and whether there were any gaps in communication that need to be
addressed.


1 Task: A patient with bronchitis was prescribed streptomycin. However, while giving him the medicine, the
pharmacist asked: “Do you have tuberculosis?” The patient replied: “No.” Arriving home, the patient felt sweating,
weakness, remembered that he had been in contact with a tuberculosis patient and developed tuberculosisophobia
(an obsessive fear of getting tuberculosis).
Questions:
2. What is before us: egrotogeny , iatrogeny, egogeny , sisterstrogeny ? Explain.
3. Did the pharmacist violate ethical principles with her question?
The bioethical problem in this scenario revolves around patient confidentiality, privacy, and the potential
exacerbation of the patient's anxiety and fear due to the pharmacist's question. The patient's fear of contracting
tuberculosis, known as tuberculosisophobia, highlights the psychological impact of healthcare interactions on
patients' well-being.
2. Definitions:
- Egrotogeny: This term refers to actions or conditions within the healthcare system that contribute to the
worsening of a patient's health or the development of new health concerns. In this scenario, the patient's fear of
tuberculosis, triggered by the pharmacist's question, could be considered a manifestation of egrotogeny.
- Iatrogeny: Iatrogeny refers to harm caused to a patient as a result of medical treatment or healthcare interactions.
While the pharmacist's question may not directly cause harm, it could exacerbate the patient's anxiety and fear,
leading to psychological distress.
- Egogeny: This term typically refers to actions or conditions that promote good health or well-being. In this
scenario, the pharmacist's question could be seen as unintentionally contributing to the patient's health concerns
rather than promoting well-being.
- Sisterstrogeny: This term is not commonly used in medical or bioethical contexts. It may refer to interactions or
conditions related to sibling relationships or support networks, but it does not directly apply to the situation
described.
3. Violation of Ethical Principles:

The pharmacist's question may be considered a violation of patient confidentiality and privacy. While the
pharmacist may have had a legitimate concern about the patient's health and safety, asking about the patient's
potential tuberculosis status in a public setting could breach the patient's right to privacy and confidentiality.
Additionally, the manner in which the question was posed could contribute to the patient's feelings of anxiety and
distress, further complicating the ethical considerations.
4. Resolving Doctor-Patient Conflict:

To resolve the conflict between the patient and the healthcare provider, it is essential to address the patient's
concerns and fears in a compassionate and respectful manner. This may involve:
- Providing reassurance and support to the patient regarding their health concerns.
- Explaining the rationale behind the pharmacist's question and addressing any misunderstandings.
- Offering additional information or resources to help the patient cope with their anxiety and fear, such as
counseling services or support groups.
- Apologizing for any distress caused and expressing a commitment to ensuring patient privacy and
confidentiality in future interactions.
- Interpersonal Communication: This scenario involves communication between the patient and the pharmacist at
the individual level. The characteristics of effective communication include sensitivity to the patient's concerns,
respect for privacy, and clear and empathetic dialogue.
- Intraprofessional Communication: The pharmacist's question also reflects communication within the healthcare
team. It underscores the importance of clear communication protocols and respect for patient confidentiality among
all members of the healthcare team.

Task: Patient K., 25 years old, came to the clinic with complaints of rashes and itching on the body. During the
examination, the doctor loudly called his colleagues to look at, as he put it, the terrible rashes that so spoil the girl’s
beauty. Patient K. was dissatisfied and said: “I am not a mannequin for viewing, I’d better turn to another specialist
for help.”
Questions:
The bioethical problem in this scenario revolves around patient dignity, respect, and confidentiality. The doctor's
behavior of loudly calling colleagues to observe the patient's rashes without her consent violates the patient's right
to privacy and dignity. It also undermines the trust and rapport between the doctor and the patient, potentially
leading to a breakdown in the therapeutic relationship.
2. Conflict Origin:
The conflict between the doctor and the patient arose due to the doctor's inappropriate behavior and lack of
sensitivity towards the patient's feelings and privacy. By drawing attention to the patient's condition without her
consent and making insensitive remarks about her appearance, the doctor violated the patient's trust and autonomy,
leading to the patient's dissatisfaction and desire to seek help elsewhere.
3. Adherence to Bioethical Principles by Doctors:

The doctor's actions in this scenario clearly violated the principles of respect for patient autonomy,
confidentiality, and dignity. The patient has the right to control who has access to her medical information and to be
treated with respect and sensitivity by healthcare providers. By disregarding these principles, the doctor failed to
uphold ethical standards of patient care.
- Interpersonal Communication: This scenario involves communication between the doctor and the patient at the
individual level. The characteristics of effective communication include empathy, respect, confidentiality, and
sensitivity to the patient's needs and preferences.
- Intraprofessional Communication: The doctor's behavior also reflects on communication within the healthcare
team. It highlights the importance of professional conduct and respectful communication among colleagues,
especially when discussing patient cases or conducting examinations.
5. Methods for Resolving Interpersonal Conflicts:

- Apology and Acknowledgment: The doctor should apologize to the patient for the inappropriate behavior and
acknowledge the impact it had on her feelings and trust. This demonstrates accountability and a commitment to
addressing the conflict.
- Education and Sensitivity Training: Provide education and training to healthcare providers on appropriate
communication skills, patient privacy, and ethical conduct. This can help prevent similar incidents in the future and
promote a culture of respect and sensitivity towards patients.
- Mediation and Facilitated Dialogue: Facilitate a dialogue between the doctor and the patient, possibly with the
assistance of a mediator or patient advocate, to address the underlying issues, clarify misunderstandings, and work
towards resolving the conflict.
- Policy and Protocol Review: Review and reinforce existing policies and protocols regarding patient privacy,
dignity, and communication within the healthcare institution. Ensure that all staff members understand their
responsibilities and obligations in upholding these standards of care.

Task : A patient came to see a therapist complaining of back pain. After the examination, the doctor prescribed
treatment and additional tests. The patient expressed reluctance to be treated with medications and inquired about
the possibility of combining treatment with traditional medicine methods.
Questions :
The bioethical problem in this scenario revolves around patient autonomy, informed consent, and the integration
of complementary and alternative medicine (CAM) with conventional medical treatments. It raises questions about
respecting the patient's preferences, ensuring informed decision-making, and navigating potential conflicts between
different treatment modalities.
2. Conflict Origin:
The conflict between the doctor and the patient arose due to differences in treatment preferences and
expectations. The patient expressed a desire to explore traditional medicine methods alongside conventional
medical treatment, while the doctor prescribed medications without considering the patient's preference for a
combined approach. This mismatch in treatment goals and approaches led to tension and disagreement between the
doctor and the patient.
3. Adherence to Bioethical Principles by Doctors:

While the doctor may have failed to fully respect the patient's autonomy and preferences initially, it's important to
note that no clear violation of bioethical principles occurred. The doctor's actions were likely based on their
professional judgment and standard medical practices. However, there may have been room for improvement in
terms of involving the patient in treatment decisions and discussing alternative treatment options more
comprehensively.
- Interpersonal Communication: This scenario involves communication between the doctor and the patient at the
individual level. The characteristics of effective communication include active listening, empathy, clarity, and
respect for the patient's perspective and autonomy.
- Intraprofessional Communication: There may also be a need for communication among members of the
healthcare team, such as between the doctor and other specialists involved in the patient's care, to coordinate
treatment plans and address any concerns or conflicts that arise.

- Shared Decision-Making: Encourage collaborative decision-making between the doctor and the patient by
discussing treatment options, including both conventional and traditional medicine approaches, and jointly
determining the best course of action based on the patient's preferences, values, and clinical needs.
- Patient Education: Provide the patient with information about the benefits, risks, and evidence-based practices
associated with both conventional and traditional medicine methods to help them make informed decisions about
their treatment.
- Negotiation and Compromise: Facilitate open and respectful dialogue between the doctor and the patient to
explore areas of agreement and identify compromises that address the patient's concerns while aligning with the
doctor's professional expertise and clinical recommendations.
- Referral to Integrative Medicine Specialists: Consider referring the patient to healthcare providers with expertise
in integrative or complementary medicine who can offer specialized guidance and support in combining
conventional and traditional treatment modalities.
- Continuous Communication: Maintain ongoing communication with the patient to monitor treatment progress,
address any emerging concerns or preferences, and adjust the treatment plan as needed to ensure optimal outcomes
and patient satisfaction.

Problem : Patient M, 54 years old, is being treated in a surgical hospital for a tumor in the lung. The nurse, who
carried out the doctor's orders, during the next manipulation, told the patient that his condition was hopeless and the
treatment would not bring any results, and perhaps he would develop lung cancer. As a result, patient M. attempted
suicide; his relatives wrote a complaint to the health authorities and filed a claim for compensation for moral
damage caused.
Questions:
2. Why did the conflict arise between the patient and the medical staff ?
3. What bioethical principles were not violated by the nurse ?
The bioethical problem in this scenario revolves around the breach of trust, patient autonomy, and the duty of
healthcare professionals to communicate effectively and responsibly with patients, especially when discussing
sensitive or potentially distressing information.
2. Conflict Origin:
The conflict between the patient and the medical staff arose due to the nurse's inappropriate and insensitive
communication regarding the patient's prognosis. By delivering such distressing news without proper context,
empathy, or support, the nurse caused emotional harm to the patient, leading to a breakdown in trust and a sense of
hopelessness.
3. Bioethical Principles Adherence:
The nurse violated several bioethical principles, including:
- Respect for Patient Autonomy: The nurse failed to respect the patient's autonomy by delivering distressing news
without considering the patient's emotional readiness or providing adequate support.
- Beneficence: The nurse's actions did not promote the well-being of the patient but instead caused psychological
harm and increased distress.
- Non-Maleficence: The nurse's communication approach caused harm to the patient by exacerbating their
emotional distress and leading to a suicide attempt.
- Veracity: While honesty is important, delivering information in a sensitive and compassionate manner is equally
crucial to uphold the principle of veracity.
- In this scenario, the communication occurred at the interpersonal level between the nurse and the patient.
- Characteristics of effective communication include empathy, active listening, clear and concise language,
sensitivity to the patient's emotional state, and respect for patient autonomy.
- Effective communication fosters trust, promotes understanding, and empowers patients to make informed
decisions about their care.

- Open Dialogue: Facilitate a constructive dialogue between the patient, their family, and the healthcare team to
address concerns, express emotions, and identify solutions collaboratively.
- Mediation: Involve a neutral third party, such as a mediator or counselor, to facilitate communication and
resolution of conflicts in a structured and impartial manner.
- Apology and Amends: Healthcare professionals should acknowledge any mistakes or inappropriate actions,
apologize to the patient and their family, and take steps to rectify the situation and prevent similar occurrences in
the future.
- Support and Counseling: Provide emotional support and counseling services to the patient and their family to
help them cope with the emotional distress caused by the conflict and its aftermath.
- Policy Review and Training: Healthcare institutions should review their policies and protocols regarding
communication with patients and provide ongoing training to healthcare professionals to enhance their
communication skills and sensitivity to patients' emotional needs.

1.Task.
A patient came to see a therapist complaining of back pain. After the examination, the doctor prescribed treatment
and additional tests. The patient expressed reluctance to be treated with medications and inquired about the
possibility of combining treatment with traditional medicine methods. Afterwards, the patient, who went to the
doctor with complaints of back pain, expressed his reluctance to be treated with the medications prescribed by the
doctor. The patient found out whether it is possible to combine drugs with traditional medicine methods. The doctor
must convince the patient that the medications prescribed to him are no less effective than traditional medicine and
do not pose any danger.
In the practice of every doctor, there will be patients who will not be satisfied with the treatment methods of
modern medicine , its procedures and medications. There will also be supporters of so-called traditional medicine.
There are quite a few of them now. Every doctor, in my opinion, needs to be convinced, or at least try to convince,
to be treated with the methods that are offered to him. My problem presents just such a case. The patient is a
supporter of traditional medicine. The situation can be considered as a task that a doctor faces to try to convince the
patient to be treated with modern medicine.
Questions :
1. Explain the situation.
2. Determine the reasons for the situation, predict possible options for its development.
3. Describe the measures already taken.
4. Write promising strategies and actions, evaluate and compare their effectiveness
1. Situation Explanation:
- The patient visited a therapist complaining of back pain but expressed reluctance to be treated with medications
prescribed by the doctor. Instead, the patient inquired about the possibility of combining treatment with traditional
medicine methods.
2. Reasons and Possible Options:

- Reasons:
- Patient's preference for traditional medicine due to personal beliefs or cultural influences.
- Concerns about the side effects or efficacy of modern medications.
- Possible Options:
- The patient continues to seek traditional medicine treatments independently.
- The patient refuses modern medical treatment altogether.
- The patient is open to discussion and education about the benefits of modern medicine.
3. Measures Taken:
- The doctor has already prescribed treatment and additional tests based on the patient's symptoms and
examination findings.
- The doctor has engaged in a conversation with the patient regarding their preferences and concerns about
treatment.
4. Promising Strategies and Actions:

- Education: The doctor can provide information to the patient about the scientific basis and evidence supporting
modern medical treatments for back pain.
- Open Dialogue: The doctor can engage in open and respectful dialogue with the patient, addressing their
concerns and discussing the potential benefits and risks of both modern and traditional treatment options.
- Collaborative Approach: The doctor can work together with the patient to develop a treatment plan that
integrates aspects of both modern medicine and traditional methods, if feasible and safe.
- Referral: If the patient remains hesitant about modern medical treatment, the doctor may consider referring them
to a specialist who has experience in integrating traditional medicine approaches into patient care.
- Follow-up: The doctor should schedule regular follow-up appointments to monitor the patient's progress and
adjust the treatment plan as needed based on their response to therapy.
- In this scenario, the doctor-patient communication involves a therapeutic relationship aimed at understanding
the patient's preferences, concerns, and beliefs regarding treatment options.
- Effective communication requires active listening, empathy, and the ability to convey medical information in a
clear and understandable manner.
- The doctor should strive to establish rapport with the patient and build trust to facilitate shared decision-making
and collaboration in treatment planning.

Task : An elderly patient came to see a doctor working for the first year after graduating from university with
complaints of pain in the epigastric area . During the conversation with the patient, it turned out that she is a deeply
religious person, all her life attitudes are connected with a religious worldview. The doctor suspected that these
complaints arose in the patient as a result of fasting.
Questions :
1. Barrier to Relationships:
- The barrier to the doctor-patient relationship in this scenario arises from the potential clash between the patient's
religious beliefs and the doctor's medical interpretation of the patient's symptoms.
2. First Signs of Conflict:

- Signs of conflict may include:
- Disagreement or tension between the doctor and patient regarding the cause of the patient's symptoms.
- Resistance from the patient to accept medical explanations or treatments that conflict with their religious
beliefs.
- Frustration or misunderstanding on both sides due to the inability to find common ground or reach a mutual
understanding.
3. Competence of the Doctor:

- The doctor's competence in this situation involves understanding and respecting the patient's religious beliefs
while providing appropriate medical care.
- The doctor should be knowledgeable about religious practices, cultural sensitivities, and their potential impact
on health and healthcare decisions.
- It's important for the doctor to communicate effectively with the patient, acknowledge their beliefs, and explore
how those beliefs may influence their health and treatment preferences.

- Active Listening: The doctor should listen attentively to the patient's concerns, demonstrating empathy and
understanding.
- Respectful Communication: Both parties should communicate respectfully, acknowledging each other's
perspectives and avoiding judgment or criticism.
- Education and Explanation: The doctor can provide information to the patient about the medical aspects of their
condition, while also acknowledging and respecting the patient's religious beliefs.
- Collaboration: The doctor and patient can work together to find a treatment plan that aligns with the patient's
religious beliefs while addressing their medical needs.
- Mediation: In cases where conflicts persist, involving a neutral mediator or religious counselor may help
facilitate communication and resolution.
5. Joint Search for a Way Out of the Conflict:

- The doctor and patient can engage in open dialogue to explore potential solutions that accommodate both the
patient's religious beliefs and the medical necessity of addressing their symptoms.
- This may involve discussing alternative treatment options, seeking input from religious leaders or counselors, or
finding ways to integrate religious practices into the patient's healthcare plan without compromising their medical
care.
- Ultimately, the goal is to find a mutually acceptable resolution that respects the patient's autonomy, preserves
their dignity, and promotes their overall well-being.

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Examination task No.

4. **Communicative Competence of a Doctor:** Communicative competence refers to a doctor's ability to

5. **Methods of Communication with Patients:**

Examination task No. 2

4. **Types of Attitude Towards Illness:**

5. **Psychological Reactions of Patients to Disease:**

Examination task No. 3

Examination task No. 4

5. **Importance of Communicative Competence:** Communicative competence is essential for building trust,

Examination task No. 5

Examination task No. 6

The form of the exam: written.

1. **Doctor's Mistakes:** The doctor made several mistakes in this situation:

Examination task No. 7

The form of the exam: written.

1. **Tactics of the Doctor:** The doctor should:

5. **Personality Questionnaires, Clinical Standardized Scale Assessment Methods, and Self-Assessment of

Examination task No. 8

The form of the exam: written.

The form of the exam: written.

5. **Methods for Resolving Interpersonal Conflicts:**

Examination task No. 10

The form of the exam: written.

4. **Resolving the Conflict:**

Examination task No. 11

3. **Communication Effectiveness:** The effectiveness of communication in healthcare involves clear,

4. **Professional Communication in Health Conservation:** Professional communication in healthcare involves

5. **Psychological Factors of a Doctor's Communicative Competence:** A doctor's communicative competence

Examination task No. 12

Doctor M., a young anesthetist at the city hospital, is called

2. **Advice for Dr. M:**

Examination task No. 13

The form of the exam: written.

3. **Skills for Effective Communication:**

4. **Barriers to Effective Communication:**

5. **Types of Attitude Towards Illness:**

Examination task No. 14

The form of the exam: written.

2. **Violations of Ethical Standards:**

4. **Conflict Structures in Medical Practice:**

5. **Medical Communication Techniques - Listening Techniques:**

Examination task No. 15

The form of the exam: written.

2. **Violation of Bioethical Principle and Deontological Rule:**

3. **Patients Susceptible to Egogeny:**

4. **Levels of Communication and Characteristics:**

5. **Techniques and Algorithms for Effective Communication in Medicine:**

Examination task No. 16

The form of the exam: written.

2. **Model of Doctor-Patient Relationship:**

5. **Legal Responsibility for Communicative Incompetence:**

Examination task No. 17

The form of the exam: written.

1. **Agreeing with Kierkegaard:**

2. **Legal Protection of Secrets:**

3. **Abolition of Medical Secrets:**

4. **Communicating Sad News:**

5. **Reducing Iatrogenesis and Medical Errors:**

Examination task No. 18

The form of the exam: written.

2. **Violation of Medical Confidentiality:**

3. **Disclosure of Medical Secrets:**

4. **Incurable Patients and Euthanasia:**

4. Communicative Competence of a Doctor: Communicative competence refers to a doctor's ability to

5. Methods of Communication with Patients:

4. Types of Attitude Towards Illness:

5. Psychological Reactions of Patients to Disease:

5. Importance of Communicative Competence: Communicative competence is essential for building trust,

1. Doctor's Mistakes: The doctor made several mistakes in this situation:

1. Tactics of the Doctor: The doctor should:

5. Methods for Resolving Interpersonal Conflicts:

4. Resolving the Conflict:

3. Communication Effectiveness: The effectiveness of communication in healthcare involves clear,

4. Professional Communication in Health Conservation: Professional communication in healthcare involves

5. Psychological Factors of a Doctor's Communicative Competence: A doctor's communicative competence

2. Advice for Dr. M:

3. Skills for Effective Communication:

4. Barriers to Effective Communication:

5. Types of Attitude Towards Illness:

2. Violations of Ethical Standards:

4. Conflict Structures in Medical Practice:

5. Medical Communication Techniques - Listening Techniques:

2. Violation of Bioethical Principle and Deontological Rule:

3. Patients Susceptible to Egogeny:

4. Levels of Communication and Characteristics:

5. Techniques and Algorithms for Effective Communication in Medicine:

2. Model of Doctor-Patient Relationship:

5. Legal Responsibility for Communicative Incompetence:

1. Agreeing with Kierkegaard:

2. Legal Protection of Secrets:

3. Abolition of Medical Secrets:

4. Communicating Sad News:

5. Reducing Iatrogenesis and Medical Errors:

2. Violation of Medical Confidentiality:

3. Disclosure of Medical Secrets:

4. Incurable Patients and Euthanasia:

5. Patient Satisfaction and Communicative Competence:

2. Fairness and Ethical Treatment:

3. Communication Skills for Initial Conversation:

4. Communication with Patients and Relatives in Traumatic Situations:

5. Conflict-Free Business Communication:

1. Violations in Clinic's Organization:

2. Ethical Violations by Manager:

4. Incurable Patients and Euthanasia:

5. Patient Satisfaction and Communicative Competence: