The Importance of Values

First year students in the Pathologists’ Assistant program at Rosalind Franklin University are enrolled in a Seminar sequence. Each quarter, the students are required to complete an Individual Development Plan (IDP), with the components varying every quarter. The purpose of the IDP is to assist students in identifying professional goals and objectives. It also allows students to assess their skill set in regards to their profession and develop a plan on how to improve those skills. The IDP is updated each quarter, so students are able to reflect on their progress throughout the program, refine their goals, and record their accomplishments. For the fall quarter, students are required to complete a literature review on the assigned topic. Students are to research and locate five to ten scholarly articles on the importance of values in healthcare.

The topic is designed to aid in the students’ professional development in the allied healthcare field. Overview of Topic Values are characteristics, beliefs, or standards of behavior that are held in significance to an individual, group, or organization. Some universally common values include compassion, honesty, friendship, open-mindedness, and loyalty. Values shape individuals in how they think and act towards ideas and one another, essentially defining their identity. They are acquired throughout life starting at a young age and are learned from family, personal experiences, communities, and educational institutions (Moyo, 2016).

Professional values are developed in the work field and often overlap with personal values. Personal values sometimes determine an individual’s profession, or at least, guide them in a particular field. Values are the foundation of an individual’s or a group’s actions and beliefs. They navigate how humans live their lives. In the healthcare field, personal and professional values are of utmost importance when providing patient care. Physicians and other healthcare professionals have the immense responsibility of monitoring their patients’ health, diagnosing diseases and cancers, along with providing treatments and cures. Moyo et al. researched numerous studies on personal and professional values and synthesized them into a single framework (Moyo, 2016). The most observable values were altruism, equality, and capability (Moyo, 2016).

These three values are common among most individuals, but it is especially necessary that healthcare professionals exhibit them consistently when providing care and collaborating with team members. Values are integral in healthcare because healthcare professionals are those responsible for making clinical decisions that will ultimately alter a patient’s health and life. This is what differentiates healthcare professional values from other professions. Relation to Pathologists’ Assistants Pathologists’ assistants are mid-level allied healthcare professionals who specialize in the field of anatomic and surgical pathology.

They perform their duties in the surgical pathology lab, autopsy suite, and often times in an office to complete administrative duties. Pathologists’ assistants do not have direct patient care, but their work is not any less important than a physician’s or surgeon’s work. They have similar, if not the same, values as other healthcare professionals. They exhibit values such as benevolence, critical-thinking, professionalism, and sympathy, along with many others. The values that are instilled in pathologists’ assistants are not only observed in their quality of work, such as grossing, but also in their ability to work as a team member.

Patients cannot directly observe these values in action, but their effects and outcomes are noticed by pathologists, surgeons, and other physicians, who in turn help guide and develop patient treatment regimens. While aligning with other healthcare professionals, pathologists’ assistants are patient-centered. Their collective values provide high quality care and place the patient first. Each and every specimen is treated with care and respect, just as physicians should treat their patients.

Pathologists’ assistants must exhibit diligence and patience, especially during difficult and tedious prosections or autopsies. For instance, pathologists’ assistants must find all the lymph nodes in a specimen, such as a colon resection, to ensure all lymph nodes are evaluated for metastasis. This task often takes time and patience, but it is vital to the patient’s diagnosis and treatment that all the lymph nodes are evaluated. Personal and professional values do not always coincide.

There can be times when their personal values conflict with their professional values, such as in the case of an elective terminated pregnancy. Dilation and evacuation (D&E) specimens are frequently received in the surgical pathology lab and in autopsy. The D&E procedure is often performed due to intrauterine demise, fetal genetic and structural abnormalities, placental insufficiency, and various other personal reasons (Ernst, 2013). The specimen’s appearance varies depending on the fetal gestational age; it may consist of fetal parts and placental tissue, or rarely, an intact fetus (Ernst, 2013). Pathologists’ assistants play a vital role in examining, describing, and photographing the specimen in order for the pathologist to make a diagnosis or identify anomalies.

In a study done by Ernst et al., researchers found there is significant importance in the pathologic examination of D&E specimens after reviewing several case findings. In relation to pathologists’ assistants, the article states: “It is helpful for these individuals [who express discomfort when grossing D&E specimens] to attend clinical/pathology conferences where findings… are presented in order to understand the relevance and value of the pathologic examination in the larger context” (Ernst, 2013). This is a situation in which pathologists’ assistants must prioritize their professional values over their personal values. One may not agree with the reason as to why a D&E was performed, but one’s professional values can influence that patient’s care in future family planning, or can provide closure for the family. It is important for pathologists’ assistants to demonstrate professional values to provide high quality health care, guide the pathologist to an accurate diagnosis, and overall contribute to the scientific research in pathology.

Search Strategy

The search tool used was the online library search on Rosalind Franklin University’s library, Boxer Library.

This tool searches multiple databases at once, including PubMed, CINAHL, MEDLINE, and more. The search was limited to English language, the last three decades (1988-2018), and peer reviewed text. The keywords searched include: “pathologic examination abortion,” “healthcare professional values,” “importance of values,” “trust in healthcare,” “distrust in healthcare,” and “communication in healthcare.” Fifteen articles were read, and seven were used for the literature review. Review of Literature In this day and age, it is no longer enough for physicians and other healthcare professionals to only excel in academia. The professional values and attributes the physicians exhibit are important to how patients perceive their doctor and the healthcare system. Patients seek the interpersonal parts of doctoring as well as the professional aspects (Halligan, 2008).

The professional values of a physician often stem from their personal values. They are learned through work experiences and patient and colleague interactions. Although, as of late, there appears to be a shift in the healthcare system from value-based care to physicians merely treating only the patient’s disease. A survey done by the General Medical Council in 2000 found that forty percent of physicians did not believe that attributes such as kindness, caring, good communication and trust, were important to medical practice (Halligan, 2008).

As Halligan states in her article “The importance of values in healthcare,” that while the medical practice is continuously improving, it has not kept up with patients’ rising expectations (Halligan, 2008). Patients are essentially clients in the healthcare system, and if they do not like the service, they will take their business elsewhere. Values, or lack thereof, can be assessed by the outcomes that they provide. Values such as trust and good communication lead to better patient-physician relationships, patient satisfaction, and overall better patient health. These represent the outcomes that demonstrate why values in healthcare are paramount.

Communication

Communication is a core component of building relationships. In healthcare, effective communication is as essential as clinical knowledge for high quality medical practice (Khan, 2017).

Communication builds a strong, trusting relationship between the patient and the physician. It is a two-way street; patients must be able to communicate openly and honestly with their physician the same way they would expect open and honest communication from their physician. Two different studies (Khan, 2017; Zschocke, 2017) demonstrate the outcomes and effects of good communication skills from the physician. In the study done by Khan et al., participating physicians were divided into an interventional group and a placebo group. The intervention group received a communication skills workshop, while the placebo was offered an academic workshop unrelated to communication.

Patients of the doctors were asked to complete a survey to evaluate the doctors’ interpersonal skills and level of satisfaction based on their interaction with the doctors. The survey was performed one month prior to and after the experiment. It was concluded that the doctors who received the communication workshop were rated significantly higher after the workshop than before. The placebo group had no significant results (Khan, 2017). Although the results were significant, the sample size of the doctors was small.

The effects of good communication could be appreciated more in a larger sample. Also, the patients were not random, since they were current patients of the sampled doctors. Formulating a relationship may take time, so the benefits of good communication may not be seen in just one month’s time. Similar to the study mentioned above, the one performed by Zschocke et al. also shows the effects of communication, but on a specific population of patients with psoriasis and their dermatologists.

Their aim was to correlate medication adherence with patient-physician interaction and communication (Zschocke, 2017). Unlike the Khan et al. study, this study surveys both the patients and the dermatologists, and it specifies certain aspects of communication in that relationship. As mentioned before, effective communication takes two participants, so surveying the physicians on communication as well helps build and improve a stronger, more open relationship with the patient. Physicians were surveyed on aspects of communication, such as time spent with patient, the content provided in that time, and consideration of the patient’s life situation. The results show that physician-patient communication does have a central impact on patient adherence (Zschocke, 2017).

Effective communication is shown to improve patient health with medication adherence and a solid patient-physician relationship. The Zschocke et al. study failed to provide the actual reason for medication non-adherence. Therefore, it cannot be concluded that poor communication is a major factor in non-adherence. Also, medication adherence is a multifactorial issue. There are several potential factors as to why patients do or do not adhere to medication, such as patient education and financial state.

The level to which communication impacts medical adherence and patient health is subjective, and therefore, difficult to evaluate and determine. Trust Along with communication, trust is another value that leads to a wide range of positive patient outcomes. It builds a stronger relationship between the patient and physician, creates a safe environment for the patient, and even enhances communication skills. The article “Public trust in the healthcare system in a developing country” mentions trust has an impact on medication adherence as well (Peters, 2016).

Peters et al. state physicians play a notable role in patients’ decisions to commit to medication regardless of financial circumstances, and those with limited resources in a developing country are less likely to comply when trust was never established (Peters, 2016). This demonstrates the importance of having trust as a value in the healthcare field. The outcome is medication adherence and improved health. Interestingly enough, the literature (Cunningham, 2007; Peters, 2016) provides insight into the difference in levels of trust between the patient-physician and patient-healthcare system. The articles note the dissimilarity between interpersonal trust and public trust. There seems to be a higher level of trust with the physician than with the healthcare system overall (Cunningham, 2007; Peters, 2016).

In a study by Peters et al., they examine the public trust of the healthcare system in Trinidad and Tobago, a developing country. A questionnaire was used to determine how many individuals view their healthcare system as trustworthy. The results showed that less than 50% of the adults surveyed indicate fair trust in the system, but their general trust in healthcare professionals was much higher (Peters, 2016). The study done by Cunningham et al. also produced similar results. HIV status patients reported distrust in the healthcare system related to HIV, but most reported trust in their physicians (Cunningham, 2007). For HIV status patients, it is vital that there is trust in the patient-physician relationship. They need to discuss sensitive information like sexual history and drug use. An open and honest discussion can lead the physician to provide better patient care. Like communication, trust is multidimensional.

Developing countries may not have the advancements or means to advancements in healthcare compared to that of a first world country, so the lack of trust in the healthcare system may be due to other factors. The study reports their findings to reflect a general dissatisfaction with the government and their failure to meet the social needs of the population (Peters, 2016).

This finding is not uncommon in the United States. Some individuals are not pleased with the government’s healthcare system, the lack of accessibility to healthcare and the financial burden associated with it. The values of the healthcare system sometimes do not match the values of physicians and patients, which causes patients to turn away. Cunningham et al. mention other patient characteristics that may affect the level of trust including race, age, gender, education, income, and insurance status (Cunningham, 2007). Overall, the articles (Cunningham, 2007; Peters, 2016) suggest that public trust is every bit as meaningful as interpersonal trust to patients and how they manage their health.

Conclusion

The literature overwhelming advocates that values in healthcare, including trust and communication, result in positive outcomes for the patients (Cunningham, 2007; Khan, 2017; Peters, 2016; Zschocke, 2017).

There is a strong patient-physician relationship, and an increase in medication compliance, which leads better patient health. When values are not present or recognized by the patients, it negatively impacts patient care and how patients view the healthcare system. As Halligan (Halligan, 2008) mentions in the her article, “Without holding on our values, there is a danger of becoming a demoralized profession.” The issue with measuring values is that it is subjective. The studies relied on patient and physician surveys and questionnaires to demonstrate what outcomes are associated with the presence of values. Patients are humans, so their state of being can fluctuate on a day to day basis.

Also, values are multidimensional. There are several factors that affect how values are noticed and expressed, and it is often difficult to differentiate which has the most impact. Ultimately, patients and their health are what matters to physicians, and they should be put first at all times. Patients seek the interpersonal relationship with their physician, in addition to receiving the best medical care from them. In that relationship, it the job of the patient and physician to express what values are important to one another, since patients can have differing values. That as well contributes to a strong relationship.