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IVMS Shaping Professionalism: AMA Medical Professionalism II

Jun 04, 2018

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    Marc Imhotep Cray, M.D.

    Shaping Professionalism:

    Medical Oaths and Codes of Ethics IIPrepared and presented by

    Marc Imhotep Cray, M.D.Basic Medical Sciences and Clinical Knowledge (CK) Teacher

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    Marc Imhotep Cray, M.D.

    Ethical Scenario

    Should physicians use surgical placebo

    controls (subjects undergo surgical

    procedures that have the appearance of

    therapeutic intervention but during which theessential therapeutic maneuver is omitted)

    when assessing the efficacy of a surgical

    intervention?

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    Surgical Placebo Controls

    The use of placebo control is not justifiedwhen testing a surgical technique that

    represents a minor improvement of an

    existing surgical procedure.

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    Surgical Placebo Controls (2)

    When a new surgical procedure is developed

    with the prospect of treating a condition for

    which no known surgical therapy exists, using

    surgical "placebo" controls may be justified butmust be evaluated in light of whether the

    current standard of care includes a non-

    surgical treatment and the benefits, risks, and

    side effects of that treatment.

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    Surgical Placebo Controls (3)

    During the informed consent process, careful

    explanation of the risks of the operation must

    be disclosed.

    Additional safeguards may include using aneutral third party to provide information and

    obtain consent.

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    Marc Imhotep Cray, M.D.

    Ethical Scenario

    What are a physicians reporting responsibilities

    if a patients medical problems impair his or her

    ability to drive safely?

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    Impaired Drivers and Their

    Physicians

    Physicians should use their best judgment

    when determining when to report impairments

    that could limit a patients ability to drive.

    In situations where there is a strong threat topatient and public safety, and where the

    physicians advice to discontinue driving is

    ignored, it is desirable and ethical to notify the

    states Department of Motor Vehicles.

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    Ethical Scenario

    Results of an experiment that does not meetcontemporary standards of human subjects

    protection is submitted for publication in a

    medical journal.

    What should the editors do?

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    Information from Unethical

    Experiments If data from unethical experiments can be

    replaced by other sources of sound data, then

    the results should not be published.

    If data from unethical experiments arescientifically valid and are the only data

    available and necessary in order to save lives,

    then publication of such information may be

    appropriate.

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    Information from Unethical

    Experiments (2)

    If the results are published, the editors

    should include a disclaimer that:

    clearly describes the unethical nature of

    the experiment; clearly states that the publication of the

    data is needed to save lives;

    pays respect to the victims;

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    Information from Unethical

    Experiments (3)

    If the results are published, the editors should

    include a disclaimer that:

    avoids trivializing trauma suffered by the

    participants; acknowledges the unacceptable nature of

    the experiments; and

    endorses adoption of higher ethical

    standards for human subjects protection.

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    Ethical Scenario

    A student is uncomfortable about medical

    students performing procedures on each

    other for educational purposes. How should

    the physician-educator respond to thestudents concerns?

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    Medical Students Performing

    Procedures on Fellow Students

    Instructors should explain to students how the

    procedures will be performed, making certain

    that students are not placed in situations that

    violate their privacy or sense of propriety. Students should be given the choice of

    whether to participate prior to entering the

    classroom.

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    Medical Students Performing

    Procedures on Fellow Students

    (contd) There should be no requirement that the

    students provide a reason for their

    unwillingness to participate.

    Students should not be penalized for refusal

    to participate.

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    Ethical Scenario

    When residents or medical students are partof a health care team, what considerations

    must be taken into account by the attending

    physician when billing for services?

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    Billing for Housestaff and Student

    Services

    When a physician assumes responsibility for

    the services rendered to a patient by a

    resident or student, the physician can bill for

    services which were performed under thesupervisory physicians direct personal

    observation, direction, and supervision.

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    Ethical Scenario

    Should consent be obtained before filmingpatients for commercial programs that will be

    publicly broadcast?

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    Filming Patients in Health Care

    Settings

    Filming patients without consent for

    commercial purposes is a violation of the

    patients privacy.

    Consent is therefore ethically required for bothinitial filming and subsequent broadcast.

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    Ethical Scenario

    A contract research organization is recruitingphysicians to participate in clinical trials that

    involve patients to whom they provide care.

    What ethical issues do physicians have to

    consider?

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    Managing Conflicts of Interest in the

    Conduct of Clinical Trials

    Physicians should only participate in trials

    that are scientifically sound and that have

    been approved by an appropriate IRB.

    The informed consent process must

    differentiate the physicians roles as clinician

    and investigator, and this is best achieved

    when someone other than the treatingphysician obtains consent.

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    Is it ethically permissible to accept gifts from

    pharmaceutical representatives?

    Ethical Scenario

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    Gifts to Physicians from Industry

    Any gift accepted by a physician should

    primarily entail a benefit to patients and should

    not be of substantial value.

    Individual gifts of minimal value arepermissible as long as they relate to the

    physicians work.

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    Marc Imhotep Cray, M.D.

    Ethical Scenario

    Is it ethically permissible for physicians to sell

    nonhealth-related goods from their offices?

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    Sale of NonHealth-Related

    Goods from Physicians Offices

    Physicians may sell nonhealth-related goods

    from their offices for the benefit of community

    organizations if:

    the goods are low cost; the physician earns no profit;

    such sales are not a regular part of the

    physicians business;

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    Sale of NonHealth-Related Goods

    from Physicians Offices (contd)

    Physicians may sell nonhealth-related goods

    from their offices for the benefit of

    community organizations if:

    such sales are conducted in a dignifiedmanner; and

    patients are not pressured into making

    purchases.

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    Ethical Scenario

    Is it appropriate to use terms such as student

    doctor to identify medical students who are

    caring for patients?

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    Medical Student Involvement in

    Patient Care

    Patients should be informed of the training

    status of individuals involved in their care.

    Terms that may be confusing when

    describing the training status of studentsshould not be used.

    Physicians should relate the benefits of

    student participation to patients and shouldensure that they are willing to permit such

    participation.

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    Marc Imhotep Cray, M.D.

    Ethical Scenario

    A medical error has occurred in the course of

    caring for a patient. Should the treating

    physician disclose this information to the

    patient?

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    Marc Imhotep Cray, M.D.

    Patient Information

    When a patient suffers significant medical

    complications that may have resulted from a

    physicians error, the physician is ethicallyrequired to inform the patient of all the facts

    necessary to ensure understanding of what

    has occurred.

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    Ethical Scenario

    In the context of managed care, should

    physicians disclose financial incentives that

    raise potential conflicts of interest to their

    patients?

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    Referral of Patients:

    Disclosure of Limitations

    Physicians must assure disclosure of any

    financial inducements that may tend to limit

    the diagnostic and therapeutic alternativesthat are offered to patients.

    Physicians may satisfy this obligation by

    assuring that the managed care plan makes

    adequate disclosure to patients enrolled inthe plan.

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    Ethical Scenario

    Should medical trainees perform procedures

    such as endotracheal intubation on the newly

    deceased patient?

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    Performing Procedures on the Newly

    Deceased Patient

    In the absence of previously expressed

    preferences, physicians should request

    permission from the family before performingprocedures.

    Without such permission, physicians should

    not perform procedures for training purposes

    on the newly deceased patient.

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    Ethical Scenario

    Should physicians treat themselves or

    members of their own families?

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    Self-Treatment or Treatment of

    Immediate Family Members Professional objectivity may be compromised

    when an immediate family member of the

    physician is the patient.

    In emergency or isolated settings, physicians

    can treat themselves or family members until

    another physician becomes available.

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    Ethical Scenario Should physicians use strikes as a tactic in

    collective bargaining?

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    Collective Action

    and Patient Advocacy Collective action should not be

    conducted in a manner that jeopardizes

    the health and interests of patients. Physicians should refrain from the use

    of the strike as a bargaining tactic.

    Alternative tactics available includeinformational campaigns and non-

    disruptive public demonstrations.

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    Ethical Scenario

    A resident has concerns that an attending

    physicians order is reflective of poor clinical

    judgment. How should this situation behandled?

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    Disputes Between Medical

    Supervisors and Trainees

    Trainees should refuse to participate in

    patient care ordered by their supervisors in

    those rare cases in which they believe theorders reflect serious errors in clinical or

    ethical judgment, or physician impairment,

    that could result in a threat of imminent harm

    to the patient or to others.

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    Disputes Between Medical

    Supervisors and Trainees (contd) Trainees may withdraw from the care ordered

    by the supervisor, provided withdrawal does

    not itself threaten the patients immediatewelfare. The trainee should communicate his

    or her concerns to the physician issuing the

    orders and, if necessary, to the appropriate

    persons for mediating such disputes.

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    Disputes Between Medical

    Supervisors and Trainees (contd)

    Third-party mediators of such disputes

    may include the chief of staff of the

    involved service, the chief resident, adesignated member of the institutional

    grievance committee, or, in large

    institutions, an institutional

    ombudsperson largely outside of thehospital staff hierarchy.

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    Disputes Between Medical

    Supervisors and Trainees

    (contd)

    Retaliatory or punitive actions against

    trainees who raise complaints are unethicaland are a legitimate cause for filing a

    grievance with the appropriate institutional

    committee.

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    Strengthening Professionalism

    Reaffirm core values and principles in

    medicine through oath taking

    Increase awareness and

    understanding of medical codes

    Promote mechanisms to encourage

    compliance with ethical guidelines Foster lifelong mentoring and the

    importance of role models

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    Future of Professionalism

    For the benefit of patients and the public,

    the future vitality of professionalism

    depends on physicians:

    Upholding and promoting the integrity of

    professional self-regulation and autonomy

    Supporting the deliberative process bywhich professional associations establish

    and promote standards for medicine

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    Declaration of

    Professional Responsibility

    Humanity is faced with unprecedented

    threats to its health and well-being

    While these threats are new, physicians

    response is guided by their historical

    commitment to care for the sick and the

    suffering A recommitment to professionalism

    underscores it as the foundation for the

    publics trust in medicine45

    Reference Resources and

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    Reference Resources andFurther Study

    Bioethics Online Study RecoursesNIH - Bioethics Resources

    University of Toronto - Joint Center for BioethicsWorld Medical Association - Medical Ethics Manual

    Virtual Mentor

    Video Education (drimhoteptv)

    IVMS-MEDICAL ETHICS & PROFESSIONALISM12 videos, 3 hrs. and 16 min.http://www.youtube.com/playlist?list=PL08E700EA3F8313EB

    E-TextbookMedical Ethics Today: The BMAs handbook of ethics

    and law Books; 3 edition (January 30, 2012)Updateshttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-today

    Best Price $148.33or Buy New $181.49

    http://bioethics.od.nih.gov/http://www.jointcentreforbioethics.ca/http://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://virtualmentor.ama-assn.org/http://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/user/drimhoteptvhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttps://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/dp/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=as1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&https://www.amazon.com/gp/offer-listing/1444337084/ref=as_li_tf_til?tag=rbwo1na-20&camp=0&creative=0&linkCode=am1&creativeASIN=1444337084&adid=1AV7D5T4Y167QXTCF3CG&http://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttp://bma.org.uk/practical-support-at-work/ethics/medical-ethics-todayhttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttps://drive.google.com/file/d/0B01zkigSrsyFeDY0WFJ0WW12T2c/edit?usp=sharinghttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://www.youtube.com/watch?v=EpKG0VbZTGo&list=PL08E700EA3F8313EBhttp://www.youtube.com/user/drimhoteptvhttp://www.youtube.com/playlist?list=PL08E700EA3F8313EBhttp://virtualmentor.ama-assn.org/http://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.wma.net/en/30publications/30ethicsmanual/index.htmlhttp://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://www.jointcentreforbioethics.ca/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://bioethics.od.nih.gov/http://www.imhotepvirtualmedsch.com/