Caring for 'Very Important Patients'--Ethical Dilemmas and Suggestions for Practical Management.

The care of Very Important Patients (VIPs) is different from other patients because they may receive greater access, attention, and resources from health care staff. Although the term VIP is used regularly in the medical literature and is implicitly understood, in practice it constitutes a wide and heterogeneous group of patients that have a strong effect on health care providers. We define a VIP as a very influential patient whose individual attributes and characteristics (eg, social status, occupation, position), coupled with their behavior, have the potential to significantly influence a clinician's judgment or behavior. Physicians, celebrities, the politically powerful, and philanthropists, may all become VIPs in the appropriate context. The quality of care may be inferior because health care professionals may deviate from standard practices when caring for them. Understanding the common features among what may otherwise be very different groups of patients can help health care providers manage ethical concerns when they arise. We use a series of vignettes to demonstrate how VIPs behavior and status can influence a clinician's judgment or actions. Appreciating the ethical principles in these varied circumstances provides health care professionals with the tools to manage ethical conflicts that arise in the care of VIPs. We conclude each vignette with guidance for how health care providers and administrators can manage the ethical concern.

Ethical dilemmas experienced by speech-language pathologists working in private practice.

Speech-language pathologists experience ethical dilemmas as they fulfil their professional roles and responsibilities. Previous research findings indicated that speech-language pathologists working in publicly funded settings identified ethical dilemmas when they managed complex clients, negotiated professional relationships, and addressed service delivery issues. However, little is known about ethical dilemmas experienced by speech-language pathologists working in private practice settings. The aim of this qualitative study was to describe the nature of ethical dilemmas experienced by speech-language pathologists working in private practice. Data were collected through semi-structured interviews with 10 speech-language pathologists employed in diverse private practice settings. Participants explained the nature of ethical dilemmas they experienced at work and identified their most challenging and frequently occurring ethical conflicts. Qualitative content analysis was used to analyse transcribed data and generate themes. Four themes reflected the nature of speech-language pathologists' ethical dilemmas; balancing benefit and harm, fidelity of business practices, distributing funds, and personal and professional integrity. Findings support the need for professional development activities that are specifically targeted towards facilitating ethical practice for speech-language pathologists in the private sector.

Social media policy in other orqanizations.

Most professional organizations have developed policy for use of social media by their members and several have developed Web sites to help members with ethical media use. It is commmon among businesses, nonprofit organizations, and government agencies to have policies governing use of media by employees when communicating with the public and provide employee training. This article samples some of the best practices in social media policy. Development of such policy represents an attractive opportunity for dentistry.

Trabalho em equipe na perspectiva da gerência de serviços de saúde: instrumentos para a construção da prática interprofissional / Team work under the perspective of health services management: instruments for the construction of inter-professional practice

Estuda-se a contribuição da ação gerencial para a promoção da prática interprofissional. Trata-se de pesquisa qualitativa, realizada em 21 serviços públicos de saúde de uma região de São Paulo, por meio de entrevista semiestruturada com 21 gerentes (diretores) e utiliza-se a técnica de análise temática. Como resultado, para promover o trabalho em equipe, os gerentes lançam mão dos instrumentos: comunicação, construção do compromisso das equipes e dos trabalhadores com o projeto institucional, estímulo à autonomia das equipes, definição de responsabilidades e accountability, promoção de mudança da cultura institucional e supervisão externa. Conclui-se que a comunicação e demais ferramentas quando aplicadas à promoção do trabalho em equipe estão orientadas ao trabalho, isto é, à atenção eficaz e eficiente às necessidades de saúde dos usuários.

Study on the contribution of the managerial action for the promotion of inter-professional practice. It is a qualitative research carried out in 21 public health services facilities in a region of São Paulo, using data from semi-structured interview with 21 managers (directors) and the technique of theme analysis was used. As a result, in order to promote team work, managers use tools such as: communication, construction of commitment on the part of teams and workers in relation to the institutional project, stimulus to team autonomy, definition of responsibilities and accountability, promotion of institutional culture change and external supervision. The conclusion is that the tool of communication and others, whenever applied to the promotion of team work, are work-oriented, that is, oriented to efficient and effective care to the health needs of the users.

Ethics in equine practice economics.

Ethics is a valuable standard for the structure of equine practice. It relies on sound moral character, beginning with the leaders in the practice. The leadership in each practice regularly needs to review its role in promoting ethical standards. This is not new information but deserves to be revisited with emphasis at this particular time in our society. Nothing less than commitment to grass root stability offers any hope to reverse those actions.

Teaching practice management skills to pediatric residents.

To satisfy the core competencies required by the Pediatric Residency Review Committee, the author describes an educational program for the residents in a large pediatric training program. The course provides a year-long overview of multiple medical management topics. The sessions cover nonclinical subjects usually missed in other educational settings, with particular focus on areas of finance, compliance, personnel management, career advancement, and leadership. The series is currently in its third year, with a positive response from the participants, and demonstrated improvement in resident knowledge of the covered areas.