Appropriate And Inappropriate Attitudes In Healthcare

3.5.06

What are morally inappropriate attitudes?
• Attitudes aimed at (in)appropriate objects.
• Attitudes aimed at appropriate objects, but had to (dis)proportionate degree.
• Attitudes expressing (in)appropriate attitudes.

Examples of appropriate attitudes:
• Empathy.
• Sympathy.
• Appropriate/proportionate feelings of anger.
• Degree of modesty/humility.
• Appropriate sense of fun?

Examples of inappropriate attitudes:
• Callousness.
• Racist, sexist, ageist and other prejudicial attitudes.
• Senseless/disproportionate anger.
• Pleasure felt at another person's displeasure/suffering.
• Inappropriate amusement.
• Excessive anxiety.

Two types of cases in which in which inappropriate attitudes may raise fitness to practice concerns
1. Where attitude threatens to negatively impact on behaviour/practice:
(i) By causing distorted/inadequate understanding of features of clinical situation.
(ii) By affecting motivation.
2. Where attitude itself is source of harm - where this may be a result of:
(i) The offence caused by the showing of that attitude.
(ii) The negative effect that attitude has on the patient-doctor relationship, and thereby the quality of car the patient is likely to receive.

Points of consideration:
1. Potential harm threatened by possession of attitude should be sufficiently severe in order to cast doubt on practitioner's fitness to practice.
2. Mitigating circumstances exist in which having of the attitude not to be taken as good indication of practitioner's overall fitness to practice.
3. How might we go about cultivating the right attitudes in ourselves and others?
-Are attitudes things that we can simply change at will?
-Might not be clear.
-May have some direct control over behaviours that will eventually impact on attitudes we have.
4. Issue of responsibility.
-Attitudes involuntary, therefore, should not be held responsible for them.
-May have some control over whether we cultivate certain attitudes in ourselves.
-Therefore, sometimes indirectly responsible for attitudes.
-People who feel wrong attitudes should not always be reproached for those attitudes.

Questions
1. In what ways do you think attitudes may impact on behaviour?
2. How do you think we can cultivate better attitudes in ourselves?
3. Do you think we should ever be punished/reproached for having certain attitudes?

Further reading
• "Tomorrow's Doctors" - GMC (2003).
• "Learning Outcomes For Attitudes, Ethical Understanding And Legal Responsibilities" - Scottish Doctor.