Medical Ethics and Professionalism. Richard L. Elliott, MD, PhD, FAPA Director, Medical Ethics and professionalism Professor, Community Medicine Mercer University School of Medicine Adjunct Professor Mercer University School of Law. Ethical dilemma?.
Richard L. Elliott, MD, PhD, FAPA
Director, Medical Ethics and professionalism
Professor, Community Medicine
Mercer University School of Medicine
Mercer University School of Law
The hospital is Catholic, which forbids direct abortion even to save the life of the mother. What do you do?
Accepted by reasonably prudent physicians that would cause a reasonably prudent patient in similar circumstances to refuse the procedure
The case of Tatiana Tarasoff in California led to the enunciation of which legal principle?
Which law led to the requirement that hospitals ask about the presence of Advance Directives?
AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;
I WILL GIVE to my teachers the respect and gratitude which is their due;
I WILL PRACTICE my profession with conscience and dignity;
THE HEALTH OF MY PATIENT will be my first consideration;
I WILL RESPECT the secrets which are confided in me, even after a patient has died;
I WILL REMAIN by all means in my power, the honor and the noble traditions of the medical profession;
MY COLLEAGUES will be my brothers and sisters;
I WILL NOT PERMIT considerations of religion, nationality, race, party politics or social understanding to intervene between my duty and my patient;
I WILL MAINTAIN the utmost respect for human life from its beginning, even under threat, and I will not use my medical knowledge contrary to the laws of humanity;
I MAKE THESE PROMISES solemnly, freely and upon my honor.
“Alternative health care”
Social justice and lack of access
235 MDs disciplined by board 1990-2003
469 MDs controlled for school and year of graduation
Unprofessional conduct (74%)
Papadakis et al. Disciplinary Action by Medical Boards and Prior Behavior in Medical School. NEJM 2005;353:2673-82
Use of drugs or alcohol 108
Unprofessional conduct 82
Conviction for a crime 46
Prescribing/acquisition substances 39
Violation of Board order/condition 32
Sexual misconduct 29
Other – Failure to meet CME, fraud, billing, failure to maintain adequate records
No gender differences
Highly significant differences (p< 0.05– 0.001)
Medical school academic performance
Unprofessional conduct in school predicted subsequent disciplinary problems
39% of disciplined physicians displayed unprofessional behaviors in school vs 19% of undisciplined physicians (disciplined physicians twice as likely to have records of unprofessional conduct during school)
Irresponsibility (>2) 8
Lack of self-improvement (>2) 3
Response to criticism
Relationships (students, nurses, faculty, patients)
Professionalism starts now
Good news – the two most significant predictors are modifiable
If you have problems with attendance, preparedness – change!
If you have a problem accepting criticism – learn!
Smiling inward is deadly
Prepare as a professional
Read the cases
Analyze using case analysis format
Discuss with colleagues as you like
Rule #! - Wear white coats to our groups