Subject(s)
Physicians, Primary Care , Attitude of Health Personnel , Humans , Morals , Surveys and QuestionnairesSubject(s)
Conflict, Psychological , Decision Making/ethics , Negotiating/methods , Patient Preference , Proxy , Advance Care Planning , HumansSubject(s)
Analgesics, Opioid , Central Nervous System Stimulants , Drug Industry , Drug Prescriptions/statistics & numerical data , Inappropriate Prescribing/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Prescription Drug Misuse/statistics & numerical data , Drug Industry/legislation & jurisprudence , Drug Overdose , Humans , Inappropriate Prescribing/legislation & jurisprudence , Prescription Drug Misuse/legislation & jurisprudence , Prescription Drug Monitoring Programs/legislation & jurisprudence , Social Responsibility , United StatesSubject(s)
Delivery of Health Care/standards , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Patient Protection and Affordable Care Act , Physician's Role , Professionalism , Guidelines as Topic , Humans , Organizational Culture , Politics , Uncompensated Care/statistics & numerical data , United StatesABSTRACT
In 2002, the Physician Charter on Medical Professionalism was published to provide physicians with guidance for decision making in a rapidly changing environment. Feedback from physicians indicated that they were unable to fully live up to the principles in the 2002 charter partly because of their employing or affiliated health care organizations. A multistakeholder group has developed a Charter on Professionalism for Health Care Organizations, which may provide more guidance than charters for individual disciplines, given the current structure of health care delivery systems.This article contains the Charter on Professionalism for Health Care Organizations, as well as the process and rationale for its development. For hospitals and hospital systems to effectively care for patients, maintain a healthy workforce, and improve the health of populations, they must attend to the four domains addressed by the Charter: patient partnerships, organizational culture, community partnerships, and operations and business practices. Impacting the social determinants of health will require collaboration among health care organizations, government, and communities.Transitioning to the model hospital described by the Charter will challenge historical roles and assumptions of both its leadership and staff. While the Charter is aspirational, it also outlines specific institutional behaviors that will benefit both patients and workers. Lastly, this article considers obstacles to implementing the Charter and explores avenues to facilitate its dissemination.
Subject(s)
Delivery of Health Care/standards , Guidelines as Topic , Physician's Role , Physicians/standards , Professionalism/standards , Adult , Female , Humans , Male , Middle Aged , Organizational CultureABSTRACT
As a medical student, I observed that different physicians had strikingly different attitudes and approaches when caring for patients. The care of one patient in particular continues to challenge my understanding of illness and moral responsibility in the practice of medicine. In this paper, I illustrate the care of this patient in order to evaluate the dominant ethics I was taught in medical school, in theory and in practice, and argue neither principlism nor the ethics of care fully captures the moral responsibility of physicians. Emphasising fidelity to the healing relationship, a core principle derived from Pellegrino's virtue theory, I conclude that this approach to clinical ethics fully explains physician responsibility. Pellegrino deconstructs the practice of medicine to clarify the moral event within the clinical encounter and offers a sufficiently useful and justified approach to patient care.
Subject(s)
Ethics, Medical , Moral Obligations , Physician-Patient Relations/ethics , Principle-Based Ethics , Virtues , Beneficence , Empathy , Ethical Theory , Humans , Narration , Patient Care Team , Philosophy, Medical , Social Justice , Students, Medical/psychologyABSTRACT
The close of the American College of Physician's (ACP) centennial year is an opportune time to reflect on the organization's important role in professional development and advocating for sound health policy. Organized medicine provides a professional home where members can participate in scholarly activities and access guidance that will help them to be better doctors. Professional organizations also serve patients by improving physicians' knowledge and skill, being a public repository of health-related information, and advocating for improvement of public health. High-functioning medical professional organizations, such as ACP, also function intentionally as moral agents through well-designed efforts to advocate for patients and the public.
Subject(s)
Morals , Patient Advocacy/ethics , Physicians/ethics , Public Health/ethics , Societies, Medical/ethics , Humans , United StatesSubject(s)
Attitude to Death , Education, Medical, Graduate/standards , Internship and Residency , Palliative Care/standards , Patient Preference , Physician-Patient Relations , Terminal Care/standards , Communication , Databases, Bibliographic , Decision Making/ethics , Education, Medical, Graduate/methods , Humans , Palliative Care/methods , Palliative Care/psychology , Professional-Family Relations , Terminal Care/methods , Terminal Care/psychologyABSTRACT
BACKGROUND: We compared two implementation approaches for a health literacy diabetes intervention designed for community health centers. METHODS: A quasi-experimental, clinic-randomized evaluation was conducted at six community health centers from rural, suburban, and urban locations in Missouri between August 2008 and January 2010. In all, 486 adult patients with type 2 diabetes mellitus participated. Clinics were set up to implement either: 1) a clinic-based approach that involved practice re-design to routinely provide brief diabetes education and counseling services, set action-plans, and perform follow-up without additional financial resources [CARVE-IN]; or 2) an outsourced approach where clinics referred patients to a telephone-based diabetes educator for the same services [CARVE-OUT]. The fidelity of each intervention was determined by the number of contacts with patients, self-report of services received, and patient satisfaction. Intervention effectiveness was investigated by assessing patient knowledge, self-efficacy, health behaviors, and clinical outcomes. RESULTS: Carve-out patients received on average 4.3 contacts (SD = 2.2) from the telephone-based diabetes educator versus 1.7 contacts (SD = 2.0) from the clinic nurse in the carve-in arm (p < 0.001). They were also more likely to recall setting action plans and rated the process more positively than carve-in patients (p < 0.001). Few differences in diabetes knowledge, self-efficacy, or health behaviors were found between the two approaches. However, clinical outcomes did vary in multivariable analyses; carve-out patients had a lower HbA1c (ß = -0.31, 95 % CI -0.56 to -0.06, p = 0.02), systolic blood pressure (ß = -3.65, 95 % CI -6.39 to -0.90, p = 0.01), and low-density lipoprotein (LDL) cholesterol (ß = -7.96, 95 % CI -10.08 to -5.83, p < 0.001) at 6 months. CONCLUSION: An outsourced diabetes education and counseling approach for community health centers appears more feasible than clinic-based models. Patients receiving the carve-out strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach. Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed.
Subject(s)
Community Health Centers/organization & administration , Delivery of Health Care/organization & administration , Diabetes Mellitus, Type 2/therapy , Health Literacy , Adult , Aged , Ambulatory Care Facilities/organization & administration , Counseling , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/psychology , Feasibility Studies , Female , Glycated Hemoglobin/metabolism , Health Behavior , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Missouri , Patient Satisfaction , Self Care , Self Efficacy , Socioeconomic Factors , TelephoneABSTRACT
BACKGROUND: The body of research is rapidly growing regarding the use of telemedicine in patient care, including cost-effectiveness, patient access, patient outcomes, etc. Less has been done describing physician communication during different aspects of the clinical visit (i.e., education, assessment, treatment, etc.) during actual versus virtual patient visits. The purpose of this study was to evaluate dermatology healthcare providers' communication via both modalities with regard to content and style. SUBJECTS AND METHODS: In-person and teledermatology patient visits were observed, audio-recorded, and transcribed over an 8-month period. A content analysis was performed. RESULTS: The Wilcoxon rank sum test was used to compare the content differences between visit modalities for each category. A p value of 0.05 was considered as significant for all tests. There were no statistically significant differences between modalities in the average number of physician words in seven of eight communication categories: small talk, clinical assessment, psychosocial issues, patient education, patient compliance, patient treatment, and administrative issues (p value range, 0.16-0.91). As well, the same communication themes occurred in each modality to essentially the same degree. For instance, assessment and discussion of treatment occurred in 100% of in-person and teledermatology visits, as did small talk. CONCLUSIONS: This research indicates that physician providers communicate with similar style and content whether using teledermatology or in-person.
Subject(s)
Communication , Dermatology , Office Visits , Physician-Patient Relations , Telemedicine , Adult , Aged , Aged, 80 and over , Dermatology/statistics & numerical data , Female , Humans , Male , Middle Aged , Missouri , Office Visits/statistics & numerical data , Qualitative Research , Tape Recording , Telemedicine/statistics & numerical data , Young AdultABSTRACT
In elderly patients with established atrial fibrillation (AF) who are receiving thyroid replacement, regular testing for thyroid function is often not performed, placing the patient at risk for iatrogenic hyperthyroidism. Of 215 patients followed in an anticoagulation clinic, 41 were receiving thyroid replacement and 15 of these were found to have hyperthyroidism. Eight had documented AF coincident with abnormal thyroid function. In addition, only 22 patients on thyroid replacement had an annual TSH. In conclusion, iatrogenic hyperthyroidism may frequently be missed in AF patients because of inadequate monitoring of serum TSH. Thyroid replacement is common in elderly patients with AF followed in an anticoagulation clinic. Laboratory evidence of hyperthyroidism occurred in 37%, usually in patients with higher doses of thyroid replacement, and often associated with AF. The frequency of iatrogenic hyperthyroidism may be underestimated in patients with AF since many patients who receive thyroid replacement therapy are not monitored regularly with serum TSH.
Subject(s)
Atrial Fibrillation/complications , Hyperthyroidism/chemically induced , Iatrogenic Disease/epidemiology , Thyroid Function Tests/statistics & numerical data , Thyroxine/adverse effects , Aged , Aged, 80 and over , Atrial Fibrillation/drug therapy , Atrial Fibrillation/epidemiology , Female , Hormone Replacement Therapy/adverse effects , Hormone Replacement Therapy/standards , Hormone Replacement Therapy/statistics & numerical data , Humans , Hyperthyroidism/drug therapy , Hyperthyroidism/epidemiology , Male , Middle Aged , Missouri , Prevalence , Retrospective Studies , Thyroxine/blood , Thyroxine/therapeutic useABSTRACT
One might argue that beneficence entails a moral obligation for health care providers and systems to adopt electronic medical records (EMR). But this argument is thwarted because EMR systems are currently not required to meet existing standards of care for health care services. Yet using EMR systems may still be prudent if benefits of adoption significantly outweigh burdens. Future moral questions regarding EMR systems will shift from obligations of adoption to that of proper use.
Subject(s)
Medical Records Systems, Computerized/ethics , Medical Records Systems, Computerized/organization & administration , Morals , Computer Security , Confidentiality , HumansABSTRACT
This essay explores the unique perspective of medical students regarding the ethical challenges of providing full disclosure to patients and their families when medical mistakes are made, especially when such mistakes lead to tragic outcomes. This narrative underscores core precepts of the healing profession, challenging the health care team to be open and truthful, even when doing so is uncomfortable. This account also reminds us that nonabandonment is an obligation that assumes accountability for one's actions in the healing relationship and that apologizing for mistakes can serve to heal. It argues that even medical students have an obligation to speak up when actions violate their moral beliefs, even if this means confronting a superior. Ethical principles cannot be abandoned in fear of adverse evaluation or failure to conform. Healthcare workers have an obligation to address mistakes made around the time of a patient's death with the patient's family. This responsibility trumps any selfish desire to avoid unpleasant feelings of guilt or regret. Such events often bring closure to already anguished relatives and spouses, and may help to facilitate the grieving process. This includes pressing forward the need to apologize to patients and/or their families when mistakes are made and when decisions are made that lead to poor outcomes for the patient, even when benevolently intended.