How the issue of pain is represented in the discourse on medical professionalism in the case of the trauma ward

Abstract

The main subject of this paper is to examine the attitudes of doctors towards pain suffered by patients. This examination largely employs the perspective of professional identity and medical professionalism. Day-to-day contacts with people suffering from pain is an inevitable part of professional activity in medicine. In this article, pain is viewed as a complex phenomenon that combines organic and socio-cultural aspects. As such, the meanings of pain can be seen as being embedded in social relations. The way doctors perceive the pain their patients suffer is mediated by human values of compassion and mercy as well as by the professional knowledge and experience, making this perception rather specific to each individual doctor.  Using results of empirical research from a series of semi-structured interviews with doctors and patients of the trauma ward in Moscow public hospital, it is shown that doctors’ perception of patients’ pain is formed as a part of their professional identity and consists of cognitive, emotional and behavioural aspects. The matter of these aspects and relation between them can vary. Emotional aspect is seen as being more flexible since it is not controlled by any official requirements and is hard to measure. The parallel between the core values of professionalism in medicine and the aspects of pain perception is drawn, concluding with the idea that real professionalism implies a balance between these three aspects. Achieving this balance depends not only on the professional experience and conscious efforts of the doctor but also on a certain attitude towards his/her work that could be described in terms of mission and vocation. Current reforms in the Russian health care system entail the introduction of neomanagerialism in this sphere and that is why medical professionalism and, correspondingly, the balanced perception of patients’ pain are facing considerable changes.