richard l. elliott, md, phd professor and director professionalism and medical ethics mercer...
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RICHARD L. ELLIOTT, MD, PHDPROFESSOR AND DIRECTOR
PROFESSIONALISM AND MEDICAL ETHICSMERCER UNIVERSITY SCHOOL OF
MEDICINEADJUNCT PROFESSOR
MERCER UNIVERSITY SCHOOL OF LAW
Professionalism and Ethics for Clinical Clerkships
Goals
Overview of professionalism and ethics in clerkships
Senior cases
Your case due March 1 Senior yearCase analysis format recommended, not
requiredOutstanding papers
http://medicine.mercer.edu/Academics/Degree%20Programs/Doctor%20of%20Medicine/ethicsoutstandingpapers
JMAG publication?
Click icon to add pictureInternal medicine
End-of-life decisions
Futility of care
Euthanasia
Physician assisted suicide
Your cases in professionalism and ethics
OB-GYN
Reproductive technologies
Genetic testing
Fetal
Maternal
Your cases
Pediatrics
Baby Doe laws and futility of care in the infant
Rights of minors
Your cases
Click icon to add pictureSurgery
Case focused
Click icon to add pictureFamily Medicine
Care of the elderly
Domestic violence
Medical errors
Your cases
Psychiatry
Competence and informed consent
Commitment
Involuntary treatment
Tarasoff
How can you tell if someone is a professional?
DressTimeliness
No Houdinis need applyPreparationHonesty
Didn’t do something, don’t know something, say so
CompetenceEthical behaviorsCourtesy and respect
Towards patients, staff, colleagues, professionWillingness to take on duties cheerfully
Confidentiality
Where do you discuss cases?With whom do you discuss cases?A friend’s 16-year old daughter visits the office where you are
working and requests birth control pills. Her family is Irish Catholic and is against birth control in any form as well as premarital sex. She requests that you do not discuss this with her parents. After concluding the visit, you return to your work area where you find a message to call the patient’s mother. In the past you have always discussed the daughter’s health issues and other concerns openly with the parents. What will you do? Do you have an obligation to the patient to maintain confidentiality? Do you have an obligation to the parents to divulge the nature of their
minor child’s medical problem? Would it be different if she had presented with a URI or athlete’s foot?
Honesty
A 68-year-old man is hospitalized with fatigue and anemia. You and another student are on call for the evening and sharing responsibilities. You conduct the admission history while your colleague performs the physical examination. You have worked with this student previously and have found him to cut corners in his work and to disappear when work assignments are distributed. During his physical examination he ‘forgets’ to perform a rectal examination or perform a stool guaiac study. During the night, the patient has a myocardial infarction as a result of an undetected gastrointestinal bleed. During rounds the next morning, the attending physician asks you whether the patient’s stool was guaiac negative.
How would you respond? If the other student falsely reports a negative guaiac what
would you do?
Scut monkey
During a night while on call, a resident asks you to go out and get sandwiches.
What do you do? Why?
Competence
A resident post call makes several errors, not washing his hands following a dirty procedure and before seeing the next patient, and prescribing amitriptyline to a patient with an arrhythmia likely to be exacerbated by the medication.
What do you do? Why?
Impairment
Another student with a history of binge drinking reports for duty smelling of alcohol. You ask about this and he says it was just an eye opener and that he has seen the attending, a well-known surgeon, do exactly the same thing.
What do you do? Why?
Duty Hours
You are told you have to do only two admissions per “shift.” The team is swamped, the intern harried, another student is out,, and a new admission comes in. The intern asks if you would see the patient.
You are at the end of the maximum time allowed for your shift. A patient you admitted is going to the OR and you would like to observe.
Issues Students Raised
Fighting with other staff in the chartsCopy and paste in EMRToo little time with patientsDiscussing patients in publicMultiple appointments to maximize billing
Rule #1
We are doctors
What does it mean to be professional?
Principles Principle of primacy of patient welfare Principle of patient autonomy Principle of social justice
Responsibilities (Commitments to __) Professional competence Honesty with patients Patient confidentiality Commitment to maintaining appropriate relations with patients Improving the quality of care Improving access to care A just distribution of finite resources Scientific knowledge Maintaining trust by managing conflicts of interest Professional responsibilities
• ANN INT MED 2002;136:243-246
What is professionalism?
PROFESSIONALISM - Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to: demonstrate respect, compassion, and integrity; a responsiveness to
the needs of patients and society that supercedes self -interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.
demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
• (ACGME, 1999)