Tag: professionalism

Blog Posts (35)

December 28, 2016

Doctor as Data Entry Drone

by Craig Klugman, Ph.D.

Most people choose to go into the health professions to help others, to make a secure living, and to challenge themselves on a daily basis.…

December 21, 2016

In Memoriam: John A. Balint, MD

After over three decades of dedicated service to Albany Medical College as a researcher, practicing physician, administrator, and mentor, when some people might consider retirement, John Balint in the early 1990’s was just beginning to redefine his career. It was during this time that I first met John at the University of Chicago, Center for Clinical Medical Ethics, when we were both members of the 1993-1994 Fellowship class. I was privileged to learn about his amazing life up to that point, but what seemed more important at that time, were his high hopes for the future.

John sought out this fellowship opportunity to prepare himself to lead the new Center for Medical Ethics which would be charged with teaching a new course that was being created in the curriculum reform process called Health, Care, and Society (HCS). To say John was excited about the new direction of his life was an understatement. As one of the leaders of this four-year longitudinal course, John was now able to focus on his deepest passion in medicine: the physician-patient relationship and the elements of good doctoring.

Of course I know now that John had been preparing for his new role from the beginning of his life. He often said his interest in the physician-patient relationship was passed along to him from his father, Michael Balint, the prominent physician-psychoanalyst and early thought leader on this topic. As a small boy growing up in Budapest, Hungary, John told me the story of joining his dad on a trip to Vienna to visit Sigmund Freud, where John played under Freud’s desk while the two men talked about their patients. Though John went on to study medicine at Cambridge University in England, and then received advanced training in gastroenterology both in England and the United States, he maintained an interest in his father’s work, which included The Doctor, The Patient, and His Illness originally published in 1957.

John came to Albany Medical College in 1963 to head the new division of gastroenterology and to put an indelible mark on the institution to which he dedicated most of his life. From having leading roles in NIH research grants, to serving as chair of the Department of Medicine and being an invaluable mentor and teacher to many students, residents, and fellows, John was a remarkably well-rounded physician-scientist. But most of all, as those who were around him in the clinical setting know, he was the consummate clinician—a good doctor in the mold of great doctors since Osler. One can hardly imagine better preparation, along with a fellowship in medical ethics, for leading the new program in ethics in Albany.

I was honored and excited when John asked me to join him as his new associate in the Center For Medical Ethics, Education and Research. When I joined him in 1994 our primary mission was to develop HCS throughout the 4 years of undergraduate training ,(the first year had begun in 1993-94), start a new clinical ethics consultation service for the physicians and nurses at Albany Medical Center, and become part of the lifeblood of the institution. John was never interested in purely theoretical pursuits in ethics—he wanted the new focus on ethics to make a positive difference in the lives of the students, patients and staff we served. Within a few years Liva Jacoby and Sheila Otto joined John and me, and together we were making our mission a reality. During our first decade working together I was honored to coauthor a number of papers with John including our 1996 article, Regaining the Initiative: Forging a New Model of the Patient-Physician Relation, which was published in JAMA.

John was a visionary who never stopped dreaming about new possibilities with a great deal of energy and enthusiasm. He was excited to support the joint Albany Medical College/Union Graduate College Master’s of Science in Bioethics as well as the new Distinction in Bioethics for our medical students, both of which began in 2001. By the time John stepped down from the directorship, the Center for Medical Ethics had become the Alden March Bioethics Institute, which has continued to grow and flourish. But it began with John’s passion to make ethics relevant in medical education and in clinical practice, and to train a new generation of young learners to become good doctors.

Though we mourn his loss, we also celebrate his remarkable life and work. He will be greatly missed, but the mission he dedicated himself to and our memory of him will continue.

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.

 

 

October 31, 2016

The Seat of Power: Spanx, Underoos and Conflation of Body Confidence with Self Confidence

The Seat of Power: Spanx, Underoos and Conflation of Body Confidence with Self Confidence

When my nephew was about 5, he decided to wear his new Spider Man Underoos over his shorts to the shopping mall. He felt it was important to have the clothing on hand “just in case” he was urgently needed, at the ready like his favorite superhero, to rescue us all from imminent danger. Or at least the harms that might be lurking at the Dillard’s in west Texas. My nephew believed deeply in the potential that his special clothing would provide magic powers, as Peter Parker’s suit offers when he is need as Spider Man. His parents disagreed, however the fact that they would not permit him to wear his special new underwear over his clothes to the mall was only as a minor setback for the determined Pre-K hero. With the compromise that he could wear them under his clothes, he embarked on the family outing fully empowered just knowing his costume was on hand. I recently reminded him of this particular outing, and his careful preparations. A decade later, this bashful but poised teenager laughed, and said he thought it was probably his brother who did tried to sport  Spider Man briefs to Dillard’s, and I was mistaken.

My question today, is about the errors we make in feeling powerful because of what we wear, specifically, what we may use to disguise our true selves in order to feel confident and – dare I say - empowered. While my beloved nephew felt a sense of empowerment because he believed superhero underwear would provide real super powers, we adults are not always so different. When I recently posed the question about ‘shapewear’ to a group of physically healthy, professionally accomplished, and socially adept women, nearly all had some experience wearing some version of the spandex underclothes with the goal of improving their outward appearance. Given the popularity, I questioned whether or not these products were anti-feminist, a new kind of corset, that squishes bellies and backsides into a kind of casing so that the body appears to have no rolls or dimples. All agreed that this was indeed conforming to social pressure regarding physical appearance, and that it was a reflection of gender norms that have simply been stitched into a different kind of product. But many were fans and suggested that the shapewear conferred a sense of confidence about how what looks in her clothes, especially when she will be in speaking in front of a group or otherwise the object of observation.

As the object of observation, there seems to be a human tendency to mistake body confidence for self-confidence. Although I initially thought this was a gendered issue, it should be noted that shapewear exits for males as well as females. Rather than an issue of females equating physique with other attributes related to skills and knowledge, it seems that presenting ourselves as slimmer, smoother, or otherwise more physically ideal is common to both males and females. Is it silly? Perhaps. Certainly, a spandex smoothed does not confer power or skill, but if it gives confidence, is that such a bad thing? Perhaps the body confidence offered by Spanx eases physical self-doubts in order to allow the wearer set aside these worries in order to focus on accentuating their strengths unrelated to appearance. Unlike the restrictive corsets of long ago, there do not seem to be any health consequences to wearing these items. Though completely unnecessary, they also seem harmless. If, like a pair of Spider Man underwear for a 5 year old, adult shapewear boosts confidence in some way, I say go ahead. Just recognize it is your wisdom, skill, and personality that will truly carry you forward – spandex, Underoos, or not. 

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.

August 9, 2016

My Patient

By Suzanne Minor The student used the phrase “my patient” six times during the brief patient interaction: “I don’t like my patients to not exercise.”  “I like it when my patients eat healthy.”  “I like it when my patients take their medications” and so on.  Many students use this phrase occasionally, but this was striking.  […]
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.…

View More Blog Entries

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).