Tag: professionalism

Blog Posts (31)

June 8, 2016

Is Being Nice Part of Being Ethical as a Healthcare Provider?

Being on the other side of the healthcare equation is always illuminating.  That is, last week I was a patient at our institution having major, elective, abdominal surgery.  Most of the care I received was kind and humane, but when it was not the negative effects were not small.  Before I “go negative” I would like to say that every nurse I encountered treated me with respect and empathy, and most did not know I was an attending physician.

But now to the negative.  An attending anesthesiologist came into my pre-operative cubicle to interview me prior to the surgery.  She started speaking very softly, and she asked me a question that I could not understand.  I told her I was hearing impaired, and that I needed her to speak up a bit, and she responded with a snort of derision.  I was shocked, and I looked over at my wife who seemed to have read the situation the same way.  She then proceeded to speak too loudly for the rest of the interview, and then stood there silently for several minutes filling out paperwork before just turning and walking out.  “Can you request another anesthesiologist,” my wife asked.  “Do you think you can trust her to take care of you while you’re asleep?’  I had no answer to these questions, and while it follows logically that her rude behavior does not directly impugn her clinical skills, she sowed a seed of doubt in my mind that even Versed (the pre-operative sedative given to patients) did not completely overcome.  Her rude behavior increased my fear and anxiety, and lessened my trust in her clinical skills.  This questioning of her abilities is emotionally justified, but it was also justified on clinical grounds as well.  My pre-operative history and physical, which she should have reviewed prior to speaking to me, documented my hearing loss, and the fact that I use hearing aids.  She came in unprepared, and then blamed me for her mistake.

Patients interviewed in a primary care setting responded that physician empathy and caring was even more important to them than physician knowledge and skill [1], but many of us have assumed that in a surgical setting patients would feel differently.  But how did I judge the skills of my surgeon except by his reputation, a warm bedside manner and thorough pre-operative informed consent discussion?  Being “nice” isn’t extra—it is the starting point of patient trust, and lack of trust undermines confidence and creates anxiety.  You would think that interpersonal skills would be less important as an anesthesiologist, but you would be wrong.  Any healthcare professional that interacts with patients needs to be well mannered, and preferably genuinely caring and compassionate.  The nursing assistant who patiently walked me around the unit at 1 am in the morning post-operatively could give lessons to the anesthesiologist. 

When it comes to medical education there has been some debate about whether we should screen for empathy or whether we can just teach it as part of the curriculum.  I think the answer is both.  Few physicians take roles that do not involve direct patient care, so rejecting applicants who have poor interpersonal skills seems both reasonable and appropriate to me.  But the “hidden curriculum” of the third and fourth year of medical school has been shown to reduce students’ empathy [2], and we as educators need to actively guard against this.  At AMC, the antidote is a longitudinal class “Health, Care, and Society (HCS).”  The course is taught over all four years of medical school, but combating the erosive effects of the clinical experience begins in the third-year.  We meet with students fifteen times during their last two years of medical school to “de-brief” them on their experiences, and help them sort out what they have witnessed.  Often we find them excusing the bad behavior of the residents and attendings, and when we challenge them on this their response is often genuine relief, because we have now allowed them to critique inappropriate behavior by their superiors.  Even more importantly, we look for positive examples of modeling that can be emulated, and fortunately students are quick to recognize these as well.  This “sorting” is critical, because at times the negative behaviors can be so commonplace as to become the norm, and students stop seeing them for what they really are. 

Last year a student told me during her Internal Medicine clerkship that she realized that many of the “nicest” residents had graduated from Albany Medical College.  It was her supposition, not mine, that the reason was HCS.  I have no idea how to test this, but if true it is the highest praise I could have received for the work we are doing.  Being “nice” isn’t extra—it is the essential starting point of patient care.

Reference:

[1] Mercer, S, Watt, G, Maxwell, M, et al. 2004.  The Development and Preliminary Validation of the Consultation and Relational Empathy (CARE) Measure:  An Empathy-Based Consultation Process Measure.  Family Practice 21(6):669-705.

[2] Neumann, M, Edelhauser, F, Tauschel, D, et al. 2011. Empathy Decline and Its Reasons: A Systematic Review of Studies With Medical Students and Residents.  Academic Medicine 86(8): 996-1009.

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 17, 2016

What’s Laremy Tunsil Got To Do With It? Professionalism, Social Media, and Medical Education

By Mark Kuczewski On April 28, 2016, ten minutes before the NFL draft of college players was to begin, the Twitter account of Laremy Tunsil of the University of Mississippi, displayed a video of him wearing a gas mask and smoking from a bong.  Mr. Tunsil was a talented prospect widely believed about to become […]
May 8, 2016

Medical errors and more medical errors

Last week the BMJ reported that annually, there are 251,000 hospital deaths due to preventable medical errors in the US. There’s some debate about the calculations that they used to arrive at that number, and about what exactly constitutes a medical error. However, rather than quibble over the fine points, let’s acknowledge that medical errors are an ethical problem that must be addressed. In this... // Read More »
May 8, 2016

Medical errors and more medical errors

Last week the BMJ reported that annually, there are 251,000 hospital deaths due to preventable medical errors in the US. There’s some debate about the calculations that they used to arrive at that number, and about what exactly constitutes a medical error. However, rather than quibble over the fine points, let’s acknowledge that medical errors are an ethical problem that must be addressed. In this... // Read More »
May 8, 2016

Medical errors and more medical errors

Last week the BMJ reported that annually, there are 251,000 hospital deaths due to preventable medical errors in the US. There’s some debate about the calculations that they used to arrive at that number, and about what exactly constitutes a medical error. However, rather than quibble over the fine points, let’s acknowledge that medical errors are an ethical problem that must be addressed. In this... // Read More »
April 29, 2016

BioethicsTV: Boundaries are Black and White on Grey’s

by Craig Klugman, Ph.D.

Reaching back to its roots, Grey’s Anatomy in its 12th season has been investigating more professional and ethical challenges in medicine.…

March 1, 2016

Code Black Ends the Season on Bioethics

BioethicsTV is an occasional bioethics.net feature where we examine bioethical issues raised in televised medical dramas.

by Craig Klugman, Ph.D.

The season finale of Code Black (season 1; episode 18 – February 24, 2016) presented a plethora of ethical challenges for the hard working doctors and nurses of Angels Memorial Hospital’s emergency department.…

February 29, 2016

A Doctor’s Personal, Religious, and Professional Struggle to Wear the Niqab

By Claudio Violato As a professor and researcher studying the experiences of physicians, including international medical doctors (IMDs), I have interviewed and studied many hundreds of doctors.  These doctors have come from over 35 countries from every continent in the world speaking more than 50 languages. I have heard their stories, why they left their […]
February 22, 2016

Four Ways to Increase Your Reflective Capacities: Heartbreak, Destroying Idols, Paradoxes, and Abandonment

By David C. Leach William Butler Yeats said: “We make out of the quarrel with others, rhetoric, but of the quarrel with ourselves poetry.” During the course of normal human development most people at some point have had their hearts broken, cherished beliefs challenged, paradoxes entertained or have been lonely or felt abandoned. Sometimes these […]
February 19, 2016

When the Patient is One of Our Own

by Craig Klugman, Ph.D.

A physician walks into the break room, looking forward to a few minutes of downtime with a cup of stale coffee and some space to breathe.…

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Published Articles (3)

American Journal of Bioethics: Volume 6 Issue 2 - Mar 2006

A Defense of Unqualified Medical Confidentiality

American Journal of Bioethics: Volume 4 Issue 2 - Jun 2004

The Professionalism Movement: Can We Pause?

American Journal of Bioethics: Volume 4 Issue 3 - Sep 2004

Charles Barkley's Dilemma: A Response to ?The Professionalism Movement: Can We Pause?? by Delese Wear and Mark G. Kuczewski (AJOB 4:2)

News (1)

July 11, 2012 6:50 pm

Professionalism: Social media mishaps (CMAJ)

One of the primary reasons medical professionalism is lagging online is that the doctors who use social media the most are from a different generation than those who know the most about maintaining the reputation of the profession. “People who have a blog or are on Twitter and Facebook tend to be on the younger side. People with more wisdom about professional boundary issues tend to be on the older side. There is a bit of a gap there and a lack of training and mentorship in this area,” says Dr. David Brendel, a psychiatrist practising in the area of Boston, Massachusetts, and a sought-after educator on matters of medical ethics and professionalism (drdavidbrendel.com).