RESUMO
There is considerable diversity in compensation models in the specialty of Emergency Medicine (EM). We review different compensation models and examine moral consequences possibly associated with the use of various models. The article will consider how different models may promote or undermine health care's quadruple aim of providing quality care, improving population health, reducing health care costs, and improving the work-life balance of health care professionals. It will also assess how different models may promote or undermine the basic bioethical principles of beneficence, non-maleficence, respect for autonomy, and justice.
Assuntos
Temas Bioéticos , Compensação e Reparação/ética , Medicina de Emergência/economia , Medicina de Emergência/ética , Modelos Econômicos , Medicina de Emergência/normas , Custos de Cuidados de Saúde , Humanos , Satisfação no Emprego , Ética Baseada em Princípios , Qualidade da Assistência à Saúde , Sociedades MédicasRESUMO
Emergency Physicians are frequently called upon to treat family members, friends, colleagues, subordinates or others with whom they have a personal relationship; or they may elect to treat themselves. This may occur in the Emergency Department (ED), outside of the ED, as an informal, or "curbside" consultation, long distance by telecommunication or even at home at any hour. In surveys, the vast majority of physicians report that they have provided some level of care to family members, friends, colleagues or themselves, sometime during their professional career. Despite being common, this practice raises ethical concerns and concern for the welfare of both the patient and the physician. This article suggests ethical and practical guidance for the emergency physician as to how to approach these situations.
Assuntos
Medicina de Emergência/ética , Família , Encaminhamento e Consulta/ética , Ética Médica , Amigos , HumanosRESUMO
People identified as Very Important Persons (VIPs) often present or are referred to the Emergency Department (ED). Celebrities are a small subset of this group, but many others are included. Triage of these patients, including occasional prioritization, creates practical and ethical challenges. Treatment also provides challenges with the risks of over testing, overtreatment, over consultation, and over or under admission to the hospital. This article presents a practical and ethical framework for addressing the care of VIPs in the ED.
Assuntos
Serviço Hospitalar de Emergência , Pessoas Famosas , Triagem/ética , Ética Médica , Hospitalização , Humanos , Segurança do Paciente , Seleção de Pacientes , Privacidade , Triagem/organização & administraçãoRESUMO
Conflicts of interest (COIs) are common in the practice of emergency medicine and may be present in the areas of clinical practice, relations with industry, expert witness testimony, medical education, research, and organizations. A COI occurs when there is dissonance between a primary interest and another interest. The concept of professionalism in medicine places the patient as the primary interest in any interaction with a physician. We contend that patient welfare is the ultimate interest in the entire enterprise of medicine. Recognition and management of potential, real, and perceived COIs is essential to the ethical practice of emergency medicine. This paper discusses how to recognize, address, and manage them.
Assuntos
Conflito de Interesses , Medicina de Emergência/ética , HumanosRESUMO
Respect for privacy and confidentiality have been professional responsibilities of physicians throughout recorded history. This article reviews the moral, religious, and legal foundations of privacy and confidentiality and discusses the distinction between these two closely related concepts. Current federal and state laws are reviewed, including HIPAA regulations and their implications for research and care in the emergency department. In the emergency department, privacy and confidentiality often are challenged by physical design, crowding, visitors, film crews, communication, and other factors. These problems are reviewed, and advice and guidelines are offered for helping preserve patients' dignity and rights to privacy and confidentiality.
Assuntos
Confidencialidade/legislação & jurisprudência , Medicina de Emergência/legislação & jurisprudência , Serviço Hospitalar de Emergência/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Pesquisa Biomédica/ética , Confidencialidade/ética , Notificação de Doenças/legislação & jurisprudência , Medicina de Emergência/ética , Serviço Hospitalar de Emergência/ética , Controle de Formulários e Registros/ética , Arquitetura Hospitalar/ética , Humanos , Notificação de Abuso/ética , Estados UnidosRESUMO
Individual physicians as well as the medical establishment were complicit in a wide range of activities carried out by the Nazis during the period that encompassed the Holocaust. This article examines these activities and lists eight moral failures attributable to physicians of this era. The accompanying article reviews the ethical pitfalls encountered by German physicians during the Nazi era and examines them in relationship to current issues. It also explores the role of professionalism then and now. In particular, ethical issues presently confronting emergency physicians are examined through this prism.
Assuntos
Ética Médica/história , Holocausto/história , Papel do Médico/história , Cumplicidade , Campos de Concentração/história , Eugenia (Ciência)/história , Alemanha , História do Século XX , Homicídio/história , Experimentação Humana/história , Humanos , Socialismo Nacional/história , Papel do Médico/psicologia , Má Conduta Profissional , Esterilização Involuntária/história , Crimes de Guerra/históriaRESUMO
Part I of this seminar in ethics reviewed the participation of German physicians and the German medical establishment in carrying out Nazi policies and listed eight moral failures that could be attributed to doctors during the dark period of history known as the Holocaust. The collective acts that occurred during this period have, arguably, become a benchmark for abject ethical collapse on the part of mankind. Part II contemplates a variety of contemporary issues through the prism of the Holocaust. This article reviews and categorizes ethical pitfalls encountered by physicians during the Nazi era and examines them in relationship to several current issues. It also focuses on ethical concerns and challenges that confront contemporary emergency practitioners, some of which have parallels, though certainly not direct comparators, in the Nazi era.
Assuntos
Medicina de Emergência/tendências , Ética Médica/história , Cumplicidade , Eugenia (Ciência)/tendências , Eutanásia/tendências , Previsões , Alemanha , História do Século XX , História do Século XXI , Holocausto/história , Experimentação Humana/história , Humanos , Notificação de Abuso/história , Obrigações Morais , Socialismo Nacional/história , Direitos do Paciente , Papel do Médico , Suicídio Assistido , Estados UnidosRESUMO
Emergency departments commonly keep files of patients who are suspected of frequently visiting them and fabricating symptoms to obtain prescription drugs, usually opioids, for nontherapeutic purposes. Such files have previously been given names such as "frequent flyer file," "repeater log," "kook-book," "problem patient file," "patient alert list," or "special needs file." Little has been written about the ethical, legal, and regulatory considerations that should be taken into account when establishing, maintaining, and using such files. This article explores these issues. The term "habitual patient files" is proposed because it is descriptive without being judgmental.