[Healthcare occupations are "different"]. / Gesundheitsberufe sind "anders"

Healthcare requires careful coordination of several occupations. In order to attain the best possible result, including effectiveness and cost-efficiency, the specific expertise of each of these occupations must be clearly defined. Healthcare occupations, physicians and nurses, are indeed professions as opposed to mere "jobs". They are concerned with living but ill human beings and not with things. Reliance on a personal capacity of judgment is a decisive aspect of professions. Healthcare professionals perform best if they are granted specific independence relative to their work.

Implicit and explicit clinical ethics support in The Netherlands: a mixed methods overview study.

Internationally, the prevalence of clinical ethics support (CES) in health care has increased over the years. Previous research on CES focused primarily on ethics committees and ethics consultation, mostly within the context of hospital care. The purpose of this article is to investigate the prevalence of different kinds of CES in various Dutch health care domains, including hospital care, mental health care, elderly care and care for people with an intellectual disability. A mixed methods design was used including two survey questionnaires, sent to all health care institutions, two focus groups and 17 interviews with managing directors or ethics support staff. The findings demonstrate that the presence of ethics committees is relatively high, especially in hospitals. Moral case deliberation (MCD) is available in about half of all Dutch health care institutions, and in two-thirds of the mental health care institutions. Ethics consultants are not very prominent. A distinction is made between explicit CES forms, in which the ethical dimension of care is structurally and professionally addressed and implicit CES forms, in which ethical issues are handled indirectly and in an organic way. Explicit CES forms often go together with implicit forms of CES. MCD might function as a bridge between the two. We conclude that explicit and implicit CES are both relevant for clinical ethics in health care. We recommend research regarding how to combine them in an appropriate way.

Moral distress and professional freedom of speech among doctors.

BACKGROUND: Previous studies indicate that Norwegian doctors experience distress in their encounter with differing and partly contradictory ideals, such as the obligation to criticise unethical and inappropriate practices. The objective of this study was to investigate the perception of moral distress and professional freedom of speech among Norwegian doctors as of today, as well as identify changes that have occurred since the previous study undertaken in 2004. MATERIAL AND METHODS: A total of 1,522 economically active doctors received a questionnaire listing various statements describing the perception of moral distress and professional freedom of speech. The responses were compared to responses to the 2004 study. RESULTS: Altogether 67% of the doctors responded to the questionnaire. The proportion who reported «fairly strong¼ or «strong¼ moral distress varied from 24% to 70% among the different statements. On the whole, the «rank and file¼ hospital doctors reported the highest degree of moral distress. Nevertheless, a decrease in the scores for moral distress could be observed from 2004 to 2010. During the same period, the perception of professional freedom of speech increased slightly. INTERPRETATION: A reduced level of distress associated with ethical conflicts in working life may be due to improved methods for handling distressing situations, or because the consequences of the health services reorganisations are perceived as less threatening now than in 2004, immediately after the introduction of the hospital reform. However, the perceived lower distress level may also be due to professional and ethical resignation. These findings should be followed up by a qualitative study.

Communication about COVID-19 from Canadian provincial chief medical officers of health: a qualitative study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) crisis, Canada's provincial chief medical officers of health (CMOHs) have provided regular updates on the pandemic response. We sought to examine whether their messaging varied over time and whether it varied across jurisdictions. METHODS: We conducted a qualitative study of news releases from Canadian provincial government websites during the initial phases of the COVID-19 outbreak between Jan. 21 and Mar. 31, 2020. We performed content analysis using a predefined data extraction framework to derive themes. RESULTS: We identified 290 news releases. Four broad thematic categories emerged: describing the government's preparedness and capacity building, issuing recommendations and mandates, expressing reassurance and encouraging the public, and promoting public responsibility. Most of the news releases were prescriptive, conveying recommendations and mandates to slow transmission. Cross-jurisdictional variations in messaging reflected local realities, such as evidence of community transmission. Messaging also reflected changing information about the pandemic over time, shifting from a tone of reassurance early on, to a sudden emphasis on social distancing measures, to a concern with public responsibility to slow transmission. INTERPRETATION: Messaging across jurisdictions was generally consistent, and variations in the tone and timing of CMOH messaging aligned with different and changing realities across contexts. These findings indicate that when evaluating CMOHs' statements, it is critical to consider the context of the information they possess, the epidemiologic circumstances in their jurisdiction and the way the province has structured the CMOH role.

Managing the conflict between individual needs and group interests--ethical leadership in health care organizations.

This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.

Moral Distress with Obstacles to Hepatitis C Treatment: A Council of Academic Family Medicine Educational Research Alliance (CERA) Study of Family Medicine Program Directors.

BACKGROUND AND OBJECTIVE: To determine whether family medicine program directors (PDs) experienced moral distress due to obstacles to Hepatitis C virus (HCV) treatment, and to explore whether they found those obstacles to be unethical. DESIGN: An omnibus survey by the Council of Academic Family Medicine's Educational Research Alliance was administered to 452 and completed by 273 US-based PDs. The survey gauged attitudes and opinions regarding ethical dilemmas in patient access to HCV treatment. RESULTS: Most of the respondents were male. Sixty-four percent of respondents believed that treatment should be an option for all patients regardless of cost. Forty-one percent believed that it was unethical to deny treatment based on past or current substance use, and 38% believed treatment should be offered to patients who were substance abusers. Moral distress was reported by 61% (score >3) of participants when they were unable to offer treatment to patients due to the patient's failure to meet eligibility criteria. In addition, PDs reporting moderate-to-high levels of moral distress were also likely to report the following opinions: 1) treatment should be offered regardless of cost, 2) it is unethical to deny treatment based on past behavior, 3) substance abusers should be offered treatment, 4) it is unethical for medicine to be prohibitively expensive, and 5) Medicaid policy that limits treatment will worsen racial and ethnic disparities. CONCLUSIONS: Currently, important ethical dilemmas exist in the access and delivery of HCV therapy. Although a diversity of opinions is noted, a significant proportion of PDs are concerned about patients' inability to avail equitable care and experience distress. In some cases, this moral distress is in response to, and in conflict with, current guidelines.

Balancing Privacy and Professionalism: A Survey of General Surgery Program Directors on Social Media and Surgical Education.

PURPOSE: Unprofessional behavior is common among surgical residents and faculty surgeons on Facebook. Usage of social media outlets such as Facebook and Twitter is growing at exponential rates, so it is imperative that surgery program directors (PDs) focus on professionalism within social media, and develop guidelines for their trainees and surgical colleagues. Our study focuses on the surgery PDs current approach to online professionalism within surgical education. METHODS: An online survey of general surgery PDs was conducted in October 2015 through the Association for Program Directors in Surgery listserv. Baseline PD demographics, usage and approach to popular social media outlets, existing institutional policies, and formal curricula were assessed. RESULTS: A total of 110 PDs responded to the survey (110/259, 42.5% response rate). Social media usage was high among PDs (Facebook 68% and Twitter 40%). PDs frequently viewed the social media profiles of students, residents, and faculty. Overall, 11% of PDs reported lowering the rank or completely removing a residency applicant from the rank order list because of online behavior, and 10% reported formal disciplinary action against a surgical resident because of online behavior. Overall, 68% of respondents agreed that online professionalism is important, and that residents should receive instruction on the safe use of social media. However, most programs did not have formal didactics or known institutional policies in place. CONCLUSIONS: Use of social media is high among PDs, and they often view the online behavior of residency applicants, surgical residents, and faculty surgeons. Within surgical education, there needs to be an increased focus on institutional policies and standardized curricula to help educate physicians on social media and online professionalism.

Bench-to-bedside review: Ethical challenges for those in directing roles in critical care units.

Though much attention in the medical literature has focused on the ethics of critical care, it seems to be disproportionately weighted toward clinical issues. On the presumption that the operational management of an intensive care unit (ICU) also requires ethical considerations, it would be useful to know what these are. This review undertook to identify what literature exists with regard to the non-clinical issues of ethical importance in the ICU as encountered by clinician-managers. We found that in addition to issues of resource allocation, there exist many areas of ethical importance to clinician-managers in the ICU that have been described only superficially. We argue that a renewed focus on ICU ethics is merited to shed light on these other, non-clinical, issues.

Dual agency and fiduciary responsibilities in modern medicine.

In today's complex medical world, physicians often face difficult decisions about whom they serve first--patients, corporations, insurance companies, the government, etc.

Dr. Rodrigo Álvarez Cambras, padre de la Ortopedia en Cuba. Homenaje en su 85 aniversario / Dr. Rodrigo Alvarez Cambras, father of Orthopedics in Cuba. Tribute in his 85th anniversary

El doctor y profesor Rodrigo Álvarez Cambras constituye una de las figuras que despuntó desde los mismos inicios del triunfo de la Revolución Cubana en las ciencias ortopédicas con repercusión en las ciencias pedagógicas. El objetivo fue argumentar porqué se considera al ilustre profesor Rodrigo Álvarez Cambras, el padre de la Ortopedia y la Traumatología en Cuba en el marco de sus 85 de aniversario. Se realizó este trabajo de corte histórico mediante sus datos biográficos y teniendo en cuenta sus principales aportes como médico, pedagogo, científico y directivo, avalados por sus más de cinco décadas dedicadas por entero a las ciencias médicas y pedagógicas. Se estimula al estudio de esta figura con el propósito de valorar su trabajo en beneficio de la sociedad cubana y su contribución al desarrollo de la medicina, específicamente de la Ortopedia y Traumatología universal (AU).

Doctor and professor Rodrigo Álvarez Cambras is one of the figures who exceled in the orthopedic and pedagogical sciences from the first moments after the triumph of the Revolution. The aim of this historic work is to sustain why the illustrious professor Rodrigo Alvarez Cambras is considered the father of Orthopedics and Traumatology in Cuba in the context of his 85th anniversary. The authors review his biographical data and his main contributions as doctor, professor, scientist, and executive, all this activities endorsed by more than five decades entirely devoted to the medical and pedagogic sciences. The study of this personality is promoted with the purpose of assessing his work in benefit of Cuban society and his contribution to the development of Medicine, especially to universal Orthopedics and Traumatology (AU).

Avoiding conflict of interest. How hospital boards can withstand close scrutiny.

With cynicism rampant over how business is conducted in the U.S., here's how hospital boards can protect themselves and their institutions from real or perceived conflicts.