Evaluation of medical ethics competencies in rheumatology: local experience during national accreditation process.

INTRODUCTION: Rheumatologists are the primary healthcare professionals responsible for patients with rheumatic diseases and should acquire medical ethical competencies, such as the informed consent process (ICP). The objective clinical structured examination is a valuable tool for assessing clinical competencies. We report the performance of 90 rheumatologist trainees participating in a station designed to evaluate the ICP during the 2018 and 2019 national accreditations. METHODS: The station was validated and represented a medical encounter in which the rheumatologist informed a patient with systemic lupus erythematosus with clinically active nephritis about renal biopsy. A trained patient-actor and an evaluator were instructed to assess ICP skills (with a focus on kidney biopsy benefits, how the biopsy is done and potential complications) in obtaining formal informed consent, delivering bad news and overall communication with patients. The evaluator used a tailored checklist and form. RESULTS: Candidate performance varied with ICP content and was superior for potential benefit information (achieved by 98.9% of the candidates) but significantly reduced for potential complications (37.8%) and biopsy description (42.2%). Only 17.8% of the candidates mentioned the legal perspective of ICP. Death (as a potential complication) was omitted by the majority of the candidates (93.3%); after the patient-actor challenged candidates, only 57.1% of them gave a clear and positive answer. Evaluators frequently rated candidate communications skills as superior (≥80%), but ≥1 negative aspect was identified in 69% of the candidates. CONCLUSIONS: Ethical competencies are mandatory for professional rheumatologists. It seems necessary to include an ethics competency framework in the curriculum throughout the rheumatology residency.

Profesión médica, ética y reumatología: ¿hacia dónde vamos? / Medical profession, ethics and rheumatology: where are we going?

The progress of medicine in the past 25 years has been extraordinary, especially in what refers to the technology. This has allowed obtaining a better quality of life of a human being that ever increases over the average of this. However, raises doubt whether in this fast-paced technological progress the medical profession has lost the vocation and the true meaning of the medicine, to be replaced by another kind of interests. A look at current medicine allows observing balance has been lost and technology has moved to the person, the disease has moved to the sick and policies of management and goals have shifted to the quality and value. Medicine is immersed in a community market that most repairs on the thing that in the human being and in this environment develops rheumatology, which without renouncing the advance, trying to keep his gaze humanist to the sick person. It’s a look to evaluate what can be done, that many times is much, and what should be done, which is guided by the ethical education and the respect to the person...

El avance de la medicina en los últimos 25 años ha sido extraordinario, especialmente en lo que se refiere a la tecnología. Eso ha permitido obtener una mejor calidad de vida de un ser humano que cada vez aumenta más el promedio de ésta. Sin embargo, se plantea la duda si en este vertiginoso avance tecnológico la profesión médica ha perdido la vocación y el verdadero sentido de la medicina, para ser reemplazada por otra clase de intereses. Una mirada la medicina actual permite observar que se ha perdido el equilibrio y la tecnología ha desplazado a la persona, la enfermedad ha desplazado al enfermo y las políticas de gestión y de metas han desplazado a las de calidad y valor. La medicina está inmersa en una comunidad de mercado que repara más en la cosa que en el ser humano y en este medio se desarrolla la reumatología, que sin renunciar al avance, intenta mantener su mirada humanista hacia la persona enferma. Es una mirada hacia lo que se puede hacer, que muchas veces es mucho, y lo que se debe hacer, que es guiado por la formación ética y el respeto a la persona...

Informed consent in rheumatology care practice.

Informed consent is a mandatory document in human subject research protocols. Its principles have been recently established in the history of Medicine, and the first official document to establish the need for an informed consent from the research subject was the Nuremberg Code (1947). All following documents confirmed that the informed consent is mandatory in human subject research. However, the informed consent, which represents patients' autonomy or self-determination regarding their relationship with their physicians, took a while to be included in medical care practice and medical deontology codes. The convenience of using the informed consent in medical practice is widely discussed today, especially in rheumatology. Our opinion is that the obligation of a signed informed consent provided by the patient for every medical procedure is neither reasonable nor practical. It should be used for more invasive or risky therapeutic procedures. We understand that the informed consent does not guarantee that the patient has been fully informed, which is an essential condition for the current rheumatological practice. Its adoption in routine medical care practice would make medical intervention bureaucratic, and, thus, quite different from the Hippocratic view, which considered the trustful physician-patient relationship fundamental for an adequate medical care practice.