Ethical concerns related to grateful patient philanthropy: the physician's perspective.

BACKGROUND: Philanthropic contributions to academic medical centers from grateful patients support research, patient care, education, and capital projects. The goal of this study was to identify the ethical concerns associated with philanthropic gifts from grateful patients. METHODS: A qualitative study design was selected. Investigators conducted in-depth semi-structured interviews with 20 Department of Medicine physicians at Johns Hopkins who were identified by Development Office staff as experienced and successful in this realm-those having relationships with multiple patients who have made philanthropic contributions. Interview transcripts were independently coded by two investigators. Content analysis identified several themes related to ethical concerns. RESULTS: Eighteen informants (90 %) were Associate Professors or Professors; two (10 %) were females. Four thematic domains emerged related to ethical concerns associated with philanthropy from grateful patients: (i) impact of gift on the doctor-patient relationship; (ii) gift acquisition considered beyond the physician's professional role; (iii) justice and fairness; and (iv) vulnerability of patients. Despite acknowledging at least one of the aforementioned concerns, eleven physician informants (55 %) expressed the view that there were no ethical issues involved with grateful patient philanthropy. CONCLUSIONS: In this paper, we report that physicians involved in grateful patient philanthropy are aware of, and in some cases troubled by, the ethical concerns related to this activity. Further studies could examine how best to prepare faculty for the challenges that may accompany these gifts so as to help them maintain expected professional and ethical standards when accepting grateful patient philanthropy.

Temporary Memory Steal: Transient Global Amnesia Secondary to Nephrolithiasis.

Transient global amnesia (TGA) is typified by an abrupt and transient anterograde amnesia, "with repetitive questioning and often variable retrograde amnesia persisting up to 24 hours." A 54-year-old male presented to our emergency department with paroxysms of left-sided flank pain, suggestive of renal colic. Computed tomography (CT) of the abdomen/pelvis revealed a three-millimeter left ureterovesicular-junction calculus. Pain control proved difficult, necessitating multiple doses of opioid and non-opioid analgesia. Subsequently, the patient developed repetitive questioning and perseveration with anterograde amnesia with a negative CT brain and unremarkable further workup. He experienced a complete resolution of symptoms within a 24-hour period, with a discharge diagnosis of TGA secondary to nephrolithiasis. This is the third case of TGA attributed to nephrolithiasis in the medical literature.

The intersection between clinical excellence and role modeling in medicine.

BACKGROUND: Role modeling is an integral component of medical education. The literature suggests that being a clinically excellent academic physician and serving as a role model for trainees are integrally related. PURPOSE: To explore the relationship between being considered clinically excellent and being considered an effective role model. METHODS: Two independent surveys were administered to clinically active faculty (asked to name clinically excellent colleagues) and internal medicine residents (asked to name faculty role models). We compared frequency counts of clinically excellent faculty mentioned and frequency counts of role models mentioned by respondents. Spearman correlations and odds ratios with 95% confidence intervals were used to assess the relationship between the responses. RESULTS: A total of 39 of 66 faculty (59%) and 45 of 50 residents (90%) responded. There were 31 faculty members judged to be clinically excellent and 67 faculty identified as role models. Thirty faculty members appeared on both lists. There was a moderately high correlation between these groups (Spearman correlation coefficient  =  0.54, P < .001). Faculty members who were among those named as clinically excellent by their peers were more likely to be named 3 or more times as a role model by trainees (odds ratio, 24.6; confidence interval, 2.9-207). CONCLUSIONS: This study tested and confirmed the correlation between clinical excellence and role modeling, illustrating the value of these faculty members at teaching hospitals.