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Islamic Medical Education Resources

Lecture to 4th year medical students at the Faculty of Medicine King Fahad Medical City Riyadh by
Professor Omar Hasan Kasule Sr 13th March 2011

1.0 PHYSICIAN DUTY TO HIMSELF

1.1 PHYSICIANS DUTY TO HIMSELF: BASIC CHARACTER

1.1.1 Iman

Three aspects of iman bear directly on medical practice: tauhid, qadar, and tafakkur. The
integrating paradigm of tauhid enables the physician to practice integrated and balanced medical.
Such care combines Islamic values and Islamic law with the best available in advanced medical
technology. Belief in qadar guides the physician in his work to know and understand that life, health,
illness, and cure are in the hands of Allah. He will understand that he is a tool and not the reason for
the cure. He will realize that the physician has limited knowledge and limited ability and should not
be arrogant. After doing all what is humanly possible for his patients, the believing physician trusts in
Allah's help and support. A believing physician will know that he cannot change the time of death,
ajal, since that is under Allah’s direct control. He will concentrate on improving quality of remaining
life for his patients. As the believing physician goes about his daily chores, he undertakes
contemplation, tafakkur, about all what he sees. Medical knowledge and actual clinical experiences
increase iman because the physician realizes the power and majesty of Allah who created the
complex human organism and who cures it from the most severe diseases.

1.1.2 Taqwat

A believing physician is conscious that Allah is watching and is ever-present. He knows that other
humans observe his actions. He will do well in public and private. He will strive to know the
permitted, halal, and do it. He will even more intensely strive to know what is prohibited, haram, and
avoid it. He will avoid being involved in prohibited medical procedures that result in destruction of
life such as abortion, euthanasia, and assisted suicide. He will keep away from fraud, false
evidence, lying and misrepresentation. He will not dispense forbidden, haram, medication.

1.1.3 Amanat

A believing physician will take his medical work as a trust, amanat. The trust involves three
dimensions: commitment and sincerity of intentions, ikhlas al niyyat; quality work, itqan & ihsan;
and the social responsibility of both da’awa and being a role model, qudwat. A sincere intention
increases commitment. Medical practice is ‘ibadat for the pleasure of Allah. Medicine is also a form
of charity. The motivation of the physician should therefore be service and not personal enrichment
and material gain. A believing physician will try to excel in his clinical responsibilities by making
sure that he tries to achieve perfection, itqaan, and excellence, ihsaan. Professional competence
cannot be compromised in any way. It is a major sin to undertake any medical procedure beyond
the level of competence of the physician. A believing physician knows that he is accountable before
Allah, the profession, and society at large. He will discharge his duties honestly using the highest
standards of good medical care. He will avoid harmful, doubtful, or unnecessary treatment. He will
strive to have regular updating of his knowledge and skills. He will engage in research for new and
better treatment modalities; every disease has a cure. A believing physician will know that he has
societal responsibilities beyond the treatment of disease. He will use any opportunities available to
make dawa to patients and their relatives. He will work to eradicate or alleviate social root causes of
disease. In his personal life he will strive to be a role model of good character and behavior for the
rest of society. He will not shy away from social leadership and advocacy for the less privileged or
the oppressed.

1.1.4 Akhlaq

The physician must have humility, tawadhu’u, show brotherhood, ukhuwwat, and have social
respectability, muru’at. He should show humility to Allah, to professional colleagues, to patients and
their relatives. He should avoid show-off, riyaa, in its manifest and hidden forms. Brotherhood is
manifested in the humane treatment and respect for all patients regardless of their disease and
social status. The believing physician gives reassurance, empathy, consolation, psychological
support for patients and relatives. He has a positive and optimistic attitude in the stress of illness.
He also fulfils the basic duties of brotherhood with his professional colleagues. Social respectability
is acquired by good public behavior and avoiding any negative behavior that violates this
respectability, khariq al muru’at. This should not be a mere show or acting in public when in private
behavior is despicable. It must be sincere and consistent with an overall good behavior.

1.2 PHYSICIANS DUTY TO HIMSELF: SELF IMPROVEMENT

1.2.1 Character development

Character, determined by personality, is internal. Its outward manifestation is behavior, good or
bad. Consistent observation of behavior over a long time reveals true character. The following are
some of the components of a positive character: Piety, generosity, charity, chastity, trust, humility,
balance, moderation, patience, endurance, cooperation, forgiving, ignoring stupid company,
reconciliation, honor and dignity, shyness, modesty, integrity, courage, and wisdom. These traits are
best manifested in an atmosphere of positive attitudes, optimism, and behavior. Positive behavior
includes: controlling appetites (eating little, fasting, sexual self-control), fulfilling needs of others,
mercy, good words and acts; and good deeds which wipe out bad ones.

1.2.2 Self-improvement

Self-improvement requires commitment, effort and action to achieve goals, taking responsibility,
learning from previous experiences (positive and negative), interdependence, pursing real needs
and not mere wants, a positive attitude, a futuristic outlook, assertiveness, self-confidence, and self
reliance, and contentment.

1.2.3 Taking charge

Being assertive is learning to take control. A person who has self-control can stand up to the
temptations of shaitan. The following are ingredients of self control: self-confidence, self-esteem,
self-reliance, self-discipline, and self-development. Self-confidence is to know yourself, your
strengths and weaknesses, to be comfortable with what you are, and to be psychologically secure.
Psychological security raises self-esteem. Self-help and self-improvement are in essence taking
charge of your life, relying on yourself in solving problems, and taking the initiative to improve. Self
discipline is needed for success and consists of control of whims and emotions, sticking to goals,
acting according to long-term and not short-term interests, avoiding impulsive acts, following the
head and not the emotions, and trusting your instincts. An entrepreneurial attitude requires initiative,
optimism, self-confidence, creativity, taking calculated risks, looking for and exploiting
opportunities, perseverance and determination.

1.2.4 Social development

Social development starts with selection of a spouse and starting a family. It involves learning to
develop social networks and taking social responsibilities in the community.

1.2.5 Professional development

The factors behind professional success are a good basic education, postgraduate training,
apprenticeship to a good mentor, setting goals and a time frame to achieve them, adopting a
growth strategy, delivering quality results in the work and not seeking cheap publicity. Professional
networking involves identification of strategic partners for mutual benefit and not manipulating or
exploitation. The networking starts within Muslim circles and extends to the wider professional and
social circles. Nurturing contacts is very important otherwise they get lost. Economic empowerment
should have the objective of eventual self-employment. A long-term development plan must be
made. Putting side some of the monthly earnings for asset accumulation and investment ensures
financial stability and expansion of the Muslim economic base.

1.3 PHYSICIANS DUTY TO HIMSELF: ETIQUETTE

1.3.1 Etiquette of teaching & learning in the health care team

The hospital health care team is complex and multi-disciplinary with complementary and inter-
dependent roles. Members have dual functions of teaching and delivering health care. Most
teaching is passive learning of attitudes, skills, and facts by observation. Teachers must be humble.
They must make the learning process easy and interesting. Their actions, attitudes, and words can
be emulated. They should have appropriate emotional expression, encourage student questions,
repeat to ensure understanding, and not hide knowledge. The student should respect the teacher for
the knowledge they have. They should listen quietly and respectfully, teach one another, ask
questions to clarify, and take notes for understanding and retention. They should stay around in the
hospital and with their teachers all the time to maximize learning.

1.3.2 Etiquette of care delivery in the health care team

Each member of the team carries personal responsibility with leaders carrying more responsibility.
Leaders must be obeyed except in illegal acts, corruption, or oppression. Rafidah was good model
of etiquette. She a kind, empathetic, a capable leader and organizer, clinically competent, and a
trainer of others. Besides clinical activities, she was public health nurse and a social worker
assisting all in need. The human touch is unfortunately being forgotten in modern medicine as the
balance is increasingly tilted in favor of technology.

1.3.3 The health care team: general group dynamics

Basic duties of brotherhood and best of manners must be observed. Encouraged are positive
behaviors (mutual love, empathy, caring for one another; leniency, generosity, patience, modesty, a
cheerful disposition, calling others by by their favorite names, recognizing the rights of the older
members, and self control in anger. Discouraged are negative attributes (harshness in speech,
rumor mongering, excessive praise, mutual jealousy, turning away from other for more than 3 days,
and spying on the privacy of others).

1.3.4 The health care team: special group dynamics

Gender-specific identity should be maintained in dress, walking, and speaking. Free mixing of the
genders is forbidden but professional contact within the limits of necessity is allowed. Patients of
the opposite are examined in the presence of a chaperone. The gaze should be lowered. Modest
and covering must be observed. Display of adornments that enhance natural beauty must be
minimized.

1.4 PHYSICIAN DUTY TO HIMSELF: DEALING WITH STRESS

1.4.1 Definition of stress

Stress is a psychological, emotional, and physiological reaction to a stressor. It is considered part

of normal human adaptation if it is within certain limits. It becomes abnormal or pathological in
situations of over-reaction such that the adverse consequences of the stress reaction cancel out the
advantages. The stress threshold varies from person to person and from stressor to stressor. What
stresses one person may not stress another one. The same individual could react to the same
stressor in different ways depending on the social and personal context. The underlying cognitive
and spiritual qualities modulate reaction to stressors.

1.4.2 Mention of stress in the Qur’an

The Qur'an has described stress as tightness, dhiiq[1], especially as tightness of the chest, dhiiq al
sadr[2]. It also has described stressful life as constricted life, ma’ishat dhankan[3]. The opposite of
stress is breadth of the chest, inshiraah al sadr[4]. Stress involves psychological stress, dhiiq nafsi
with physical symptoms and signs appearing later. Stress is breakdown of normal psychological
equilibrium, i’itidaal

1.4.3 Causes of stress

Stressful events are traumatic, uncontrollable, and unpredictable. Examples are: trauma,
temperature, emotions. Travel is a cause of stress likened to punishment[5]. It is part of human
nature to be inpatient, al ajalat fitrat insaniyat[6]. Thus when confronted by a problem that cannot be
resolved quickly they become stressed. Life is full of difficulties. Allah helps those in difficulty. He
causes difficulty to be removed by ease, zawal al usr bi al yusr[7]. Each difficulty, ‘usr, is
accompanied by what makes it easy, yusr[8]. Patience is called for in moments of difficulty.
However many people when in trouble forget this and fall into stress.

1.4.4 Reaction to stress

Psychological reactions to stress is anxiety, anger, aggression, apathy and depression, cognitive
impairment. The physiological reaction to stress manifests as the usual signs of adrenaline
releases. Long-term stress affects good health.

1.4.5 Coping with stress

People cope with stress in different ways. Coping with stress may be by denial, projection,
repression, rationalization, or reaction formation. The type of reaction also depends on the
personality type, spiritual preparation, and experience in life.

1.5 PHYSICIANS DUTY TO HIMSELF: OTHERS (Ethics of the Medical Profession by the Saudi
Council for Medical Specialties)

· Contentment with what Allah has provided

· Control the tongue

· Seeking knowledge

· Perform religious duties

· Good intentions and sincerity

· Take care of appearance

· Maintain high moral standards

· Join scientific societies

· Act earnestly and diligently

· Take care of physical and psychological health

· Protect himself from medical malpractice risks

· Abide by professional rules and regulations

· Seek advice from senior doctors

· Know the limits of his professional ability

2.0 PHYSICIAN"S DUTY TO THE PROFESSION:

2.1 Service

Medicine should be taught as a social service with the human dimension dominating the biomedical
dimension. Medicine should be practiced as of mutual social support. Medical education should
prepare the future physician to provide service to the community. This will require skills of
understanding and responding to community needs that can be acquired by spending part of the
training period in a community setting away from the high technology hospital environment.

2.2 Leadership

The medical school curriculum and experience should be a lesson in social responsibility and
leadership. The best physician should be a social activist who goes into society and gives
leadership in solving underlying social causes of ill-health. The physician as a respected opinion
leader with close contact with the patients must be a model for others in moral values, attitudes,
akhlaq, and thoughts. He must give leadership in preventing or solving ethical issues arising out of
modern biotechnology. He must understand the medical, legal, and ethical issue involved and
explain them to the patients and their families so that they can form an informed decision. He should
also provide leadership in advocating for the less privileged and advocacy for human rights.

2.3 Research

2.3.1 Importance of research in Islam:

Islam puts emphasis on seeking knowledge. The search for knowledge is a difficult but necessary
process as we learn from the story of Musa and the righteous man. Islam encourages benefiting and
using knowledge. There is no consideration for knowledge not accompanied by practical
application. Tadabbur involves critical observation and consideration of information. Tadabbur
involves critical consideration of information. Humans are encouraged to derive empirical
knowledge from observation of the earth and their own bodies. The observation referred to is
serious and deliberative, al nadhar bi al tadabbur. Tadabbur is required even with the holy text of
the Qur’an. Thought can be based on empirical observation. The observation can be of the earth. It
can also be by observation of the human body. Islam encourages active intellectual effort in looking
for knowledge. The process of ijtihad is exertion of maximum intellectual effort to discover the truth
or understand the relation between truths. Ijtihad is also used to discover and identify falsehoods.
There are parallels between the tools of ijtihad used by classical Muslim scholars and the
processes of reaching conclusions in modern scientific research. The process of inductive logic
used in medical research is the same as qiyaas usuuli used by scholars of the methodology of the
Law. The process of reaching a scientific consensus is similar to the process of scholarly
consensus. The prophet taught that there is a cure for every disease. There is an injunction to
search for cures by processes of medical research.

2.3.2 Developing a scientific culture:

· The mind must be trained to observe, analyze, think and act in a scientific manner. Blind
following is condemned. Knowledge should be spread. Ignorance spreads when knowledge is
lifted. Knowledge removes blind following. Knowledge is acquired by study. Humans were ordained
to read. Knowledge is so important that migration in its search is encouraged. Travel in search of
knowledge is encouraged. Severe punishment is reserved for those who know and hide their
knowledge from others. There is punishment for speaking without knowledge. Knowledge by itself is
not useful unless it is associated with work

· Understanding: understanding is deeper than knowing. It is possible but not desirable to

know without understanding. Understanding is not possible without knowing.

· Thinking: thinking is very important in science. Thinking can lead to new knowledge or to
deeper understanding or appreciation of existing knowledge. Thinking by observing the
environment around us: living and non-living things. Thefreedom of thought and freedom of belief are
necessary for thought to flourish.

· Description of the constant laws of nature: the laws of nature are fixed and stable. The
laws operate in various situations: in change, reproduction, parity, in the past and in the present.
Order is one of the most important laws of nature.

· Evidence-based knowledge and action: knowledge must be evidence-based. Certain

validity conditions must be fulfilled before evidence is accepted. False evidence is rejected.
Knowledge not based on evidence such as sorcery is rejected. Speculation or conjecture are
rejected because they are the most untruthful discourse not being evidence-based. Speculative or
hypothetical thinking not related to reality is condemned. Human thought is a tool and not an end in
itself. It operates on the basis of empirical observations and revelation, both objective sources of
information. Thought that is not based on an empirical basis or revelation is speculative and leads
to wrong conclusions. Care should be taken in giving opinions on matters for which there is no
evidence.

· Objectivity: objectivity is enjoined in measurements. Subjective feelings should not be

followed. Personal whims should not be followed because they lead to falsehood.

· Drawing conclusions from empirical observation: reliance of observation and not

speculation is emphasized. Humans should observe the signs of the creator in the universe and in
humans. They however should be aware that human senses have limitations.

· Rational thinking and logical operations: assertions based on reason have rational
thinking behind them. Logical operations related to rational thinking can be identified.

· Prudence in reaching conclusions: even with the most rigorous empirical observation,
care must be taken in reaching conclusions because errors are always possible.

· Asking questions: questions can be for finding out information. Too much speculative
questioning on hypothetical situations is discouraged.

· Respecting the other opinion: opposing opinions should be listened to and should be
respected. They should never be suppressed.

· Abandoning false premises: if a person gives an opinion on a matter and then receives a
correct information or interpretation, he should give up his previous opinion.

· Truth: fear of people should be no reason for not revealing the truth. Deception is
condemned. The truth of any assertion must be checked. Certainty is the basis of knowledge;
speculation is not.

· 2.4 PHYSICIAN'S DUTY TO HIS PROFESSION : OTHERS (Ethics of the Medical

Profession by the Saudi Council for Medical Specialties)

· Personal conduct, personal appearance, and devotion to the profession

· Avoid actions that cause contempt for the profession

· Contribute to the scientific and practical development of the profession

· Avoid misusing the profession for personal gain

· Respect standards of behavior in the conduct of the work

· Observe standards of the medical profession

· Take appropriate measures when a member of the profession does not follow accepted
standards

· Honesty and integrity in dealing with patients

· Avoid hasty decisions in risky procedures

· Avoid seeking fame at the expense of the profession

NOTES

[1] Qur’an 6:125

[2] Qur’an 11:12, 15:97

[3] Qur’an 20:124

[4] Qur’an 94:1

[5] Bukhari K26 B19

[6] Qur’an 17:11

[7] Qur’an 2:185

[8] Qur’an 94:5-6