ABSTRACT
The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care.
Subject(s)
Employment/ethics , Ethics, Medical , Physicians/ethics , Practice Management, Medical/ethics , Professionalism , Contracts/ethics , Fee-for-Service Plans , Humans , Physician-Patient Relations , Private Practice/ethics , Referral and Consultation/ethics , Reimbursement, Incentive , United States , Value-Based Health InsuranceABSTRACT
Research is an intrinsic part of both academia and clinical best practice. Within an academic environment, this can include access to advice and guidance from trained professionals. Similarly, while sometimes overly risk-averse, within the NHS there is a structured and systematic approach to healthcare research. However, in the UK, a large number of specialist dental procedures take place within the private healthcare system, which does not have access to such support and guidance. How, then, can we generate our own dental research from private dental primary care settings? With a number of phrases becoming part of everyday vocabulary in dental primary care, such as practice-based research, patient-centred outcomes, evidence-based dentistry, it is time to consider this. From research ethics to writing papers, via GCP, IRAS, HEIs and MOOCs, this article summarises the experiences of one non-affiliated (non-academic, non-NHS) private dental practice attempting to enter the world of research. The authors discuss their experiences, share the multiple sources of support encountered along the way, and demonstrate the benefits to everyday practice gained by initiating research studies.
Subject(s)
Dental Research/organization & administration , Private Practice/organization & administration , Dental Research/economics , Dental Research/ethics , Ethics, Research , Evidence-Based Dentistry , Humans , Private Practice/economics , Private Practice/ethics , Research Support as Topic , United KingdomSubject(s)
Biomedical Research/ethics , Ethics Committees, Research/ethics , Private Practice/ethics , Surgeons/ethics , Surgery, Plastic/ethics , Biomedical Research/economics , Financing, Government/ethics , Humans , Private Practice/economics , Research Support as Topic/ethics , Surgeons/economics , Surgery, Plastic/economicsABSTRACT
BACKGROUND: Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia. METHODS: A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented. RESULTS: Of 608 eligible GPs invited to participate during the study period, 547 (89.9%) consented and completed the interview. A low proportion of GPs (24.6-74.3%) had heard of the International Standards for TB care (ISTC) and only 41.2-68.9% of these GPs had participated in ISTC training. As few as 47.3% (90% CI: 37.6-57.0%) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0-5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6%. In all cities, a substantial proportion of GPs (12.0-45.5%) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8-52.0%). CONCLUSIONS: The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions.
Subject(s)
Antitubercular Agents/therapeutic use , General Practitioners/ethics , Practice Patterns, Physicians'/statistics & numerical data , Private Practice/ethics , Tuberculosis, Pulmonary/drug therapy , Adult , Cities , Cross-Sectional Studies , Disease Management , Drug Resistance, Bacterial/drug effects , Female , General Practitioners/education , Health Care Surveys , Humans , Indonesia , Male , Middle Aged , Practice Guidelines as TopicABSTRACT
This paper summarizes the difficulties that may emerge when the same care-provider attends to private and public patients within the same or different clinical settings. First, I argue that blurring the boundaries between public and private care may start a slippery slope leading to "black" under-the-table payments for preferential patient care. Second, I question whether public hospitals that allow their doctors to attend to private patients provide an appropriate learning environment for medical students and residents. Finally, I propose a way to both maintain the advantages of private care and avoid its negative consequences: complete separation between the public and the private health care systems.
Subject(s)
Delivery of Health Care/organization & administration , Ethics, Medical , Physicians/organization & administration , Private Practice/organization & administration , Public Health/methods , Delivery of Health Care/economics , Delivery of Health Care/ethics , Education, Medical/methods , Humans , Israel , Physicians/economics , Physicians/ethics , Private Practice/ethicsABSTRACT
In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.
Subject(s)
Ethical Analysis/methods , Ethical Theory , Physical Therapy Modalities/ethics , Private Practice/ethics , Humans , Morals , Professional-Patient RelationsABSTRACT
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.
Subject(s)
Ethics, Professional , Private Practice/ethics , Professional Role , Speech-Language Pathology/ethics , Adult , Codes of Ethics , Female , Humans , Interviews as Topic , Middle Aged , Patient Safety , Practice Management/ethics , Professional Autonomy , Qualitative Research , WorkloadABSTRACT
La continua mejora de la calidad de atención psicoeducativa es uno de los pilares fundamentales que deben tener en cuenta las instituciones y centros que prestan este tipo de servicio, dado que es un aspecto esencial para responder a las necesidades de los clientes. En este sentido, el presente artículo evalúa el resultado de diez años de intervención educativa en el área de infantil desde una perspectiva descriptiva. El objetivo principal es determinar la evolución de nuestro trabajo tanto en las técnicas utilizadas como en los resultados obtenidos. El análisis se ha llevado a cabo con 277 casos que componen la muestra. Los resultados indicaron que el proceso de intervención llevado a cabo ha sido satisfactorio y sugieren la necesidad de considerar la interacción de múltiples factores para explicar el desarrollo de las mejoras y la importancia de considerar todas las variables contextuales que pueden ejercer influencia sobre nuestros clientes
The continuous improvement of the quality of attention educational psychology it is one of the fundamental props that must bear in mind the institutions and centers that give this type of service, provided that it is an essential aspect to answer to the needs of the patients. In this respect, the present article evaluates the result of ten years of educational intervention in the area of infantile from a descriptive perspective. The principal aim is to determine the evolution of our work so much in the technologies used like in the obtained results. The analysis has been carried out by 277 persons who compose the sample. The results indicated that the process of intervention carried out has been satisfactory and they suggest the need to consider the interaction of multiple factors to explain the development of the improvements and the importance of considering all the contextual variables that can exercise influence on our clients
Subject(s)
Humans , Male , Female , Private Practice/ethics , Education/methods , Psychology, Applied/education , Cognition Disorders/metabolism , Cognition Disorders/psychology , Education, Continuing/methods , Family Therapy/methods , Private Practice/standards , Education/standards , Psychology, Applied , Cognition Disorders/rehabilitation , Cognition Disorders/therapy , Education, Continuing/standards , Review Literature as Topic , 35174 , Family TherapyABSTRACT
OBJECTIVE: Despite the frequency of ethical issues arising in patient care, ethical discourse in the rheumatology literature is negligible. To better understand the scope of ethical problems occurring in our specialty, the American College of Rheumatology (ACR) Committee on Ethics and Conflict of Interest surveyed ACR members. Specific objectives of the survey were 1) to learn the perceived frequency of ethical issues in rheumatology, 2) to identify activities that pose ethical problems in rheumatologic practice, 3) to determine the extent of education on, and self-perceived knowledge about, ethics among ACR members, and 4) to determine member interest in, and suggest content for, future ACR-sponsored educational activities related to bioethics. METHODS: The survey included 12 non-open-ended questions addressing 5 core areas: 1) ethical dilemmas in daily practice, 2) ethical concerns in basic and clinical research, 3) influence of industry, 4) ethics of regulatory policies, potential conflicts, and disclosure, and 5) personal education on and interest in ethics. Two open-ended questions were also included, asking respondents to list the ethical issues most relevant to rheumatology and to provide any comments. Data analysis was descriptive. RESULTS: Seven hundred seventy-one responses were received. Respondents believed that ethical issues arise most frequently in practice and in clinical research. The most common ethical issues cited were the high cost of treatment for patients (51% of respondents) and for society (48%), and the practice of defensive medicine (45%). CONCLUSION: The survey results suggest that ethical problems in rheumatology are of concern to the ACR membership. Further, there is a perceived need for educational programs targeted at helping members address such professional challenges.
Subject(s)
Data Collection , Rheumatology/ethics , Rheumatology/organization & administration , Societies, Medical , Biomedical Research/ethics , Ethics , Ethics, Professional/education , Female , Humans , Male , Private Practice/ethics , Surveys and Questionnaires , United StatesABSTRACT
BACKGROUND: An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. METHODS: A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. RESULTS: One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. CONCLUSIONS: In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed.