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ETHICAL CROSSROADS ALONG THE WAY

ETHICAL CROSSROADS ALONG THE WAY. STORIES ABOUT MEDICAL TRAINING AND PSYCHIATRY John Maher MD FRCPC Whitby Mental Health Centre, Canada. WHY TELL STORIES?.

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ETHICAL CROSSROADS ALONG THE WAY

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  1. ETHICAL CROSSROADS ALONG THE WAY • STORIES ABOUT MEDICAL TRAINING AND PSYCHIATRY • John Maher MD FRCPC Whitby Mental Health Centre, Canada

  2. WHY TELL STORIES? • “Insofar as ethics occurs in the context of human relationships, our ability to discern right from wrong and good from bad depends to a significant extent on how open we allow ourselves to be to others…

  3. WHY TELL STORIES? • By sharing and comparing stories we learn to better appreciate where our lives and experiences intersect with the lives and experiences of others. • Ethics takes place at this intersection…

  4. WHY TELL STORIES? • In a very real and important sense, the ethical landscape of each clinical encounter is subtly negotiated through shared understanding. Through sharing we cultivate empathy,and from empathy we internalize the motivation to behave toward others as we ought…

  5. WHY TELL STORIES? • Empathy is the impetus to respect, and respect is the core of ethics. • Narrative is the mechanism that brings it all together.” • Workman S, Hubert J, Byers R, Jaggi R, Jantz A; CMAJ, May 9, 2006; 174(10), p. 1453

  6. MALAISE: The feelings that guide us • 1) Clinical Malaise (head) • 2) Moral Malaise (head/heart) • 3) Interpersonal Malaise (heart) • 4) Freudian Malaise (heart of hearts) • 5) Spiritual Malaise (heart and soul)

  7. Medical School • What I knew before I got there… • Philosophy • Medical Ethics • Health Services • Health Policy

  8. Medical School • “Are you Christian?” • “Medical Student” or “Student Doctor”? • “Hello Dearie” • “Do you drink a lot of alcohol?” • My policy beliefs • Go along to get along…

  9. Clerkship • Exhaustion, stress, codes • A fair call schedule • “Jump on him!” • Stat to surgery • CARMS

  10. Year 1 – Rotating Internship • Black Day in July • Different strokes for… • Post-kidney transplant • Pronouncing death

  11. Year 1 – Rotating Internship • A problem with blood pressure • Abortion clinic • “Butcher B.” and the truth • A supervisor’s woes

  12. YEARS 2 to 5 - RESIDENCY • 9 years in 5 • Growing autonomy • Essential paternalism • Certifying someone • Saudi perspectives

  13. YEARS 2 to 5 - RESIDENCY • Attitudes towards BPD • Serge was beat up • Changing a report after a suicide • A mercenary’s story • Being Chief Resident • FITRE • Not invited back

  14. IN PRACTICE • Informal opinion: “Do I need to see a doctor?” • Pill exchange • “I want my gun back” • Alcohol and harm reduction • Drug company money

  15. IN PRACTICE • Nurse accused of assault • Inadequate response to suicide attempt • “Dreams”, hit and run, assault • Hit man & a disability application • A colleague refusing consults • ACT Team

  16. AND THE STORY CONTINUES… • Where are the heroes of bioethics? (Freedman) • C.S. Lewis, The Great Divorce, and the real heroes… • Going on safari…

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