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Finder SG, Bartlett VL. Clinical Ethics Consultations and the Necessity of NOT Meeting Expectations: I Never Promised You a Rose Garden. HEC Forum 2024; 36:147-165. [PMID: 36125648 PMCID: PMC9486785 DOI: 10.1007/s10730-022-09496-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
Clinical ethics consultants (CECs) work in complex environments ripe with multiple types of expectations. Significantly, some are due to the perspectives of professional colleagues and the patients and families with whom CECs consult and concern how CECs can, do, or should function, thus adding to the moral complexity faced by CECs in those particular circumstances. We outline six such common expectations: Ethics Police, Ethics Equalizer, Ethics Superhero, Ethics Expediter, Ethics Healer or Ameliorator, and, finally, Ethics Expert. Framed by examples of requests for ethics consultation that illustrate each kind, along with brief descriptions, we argue that while these expectations ought to be resisted for clear and practical reasons, they also create opportunities for CECs to articulate, educate, and ultimately be responsible to the professional demands of clinical ethics work. Recognizing, acknowledging, and at times resisting those expectations thus become key activities and responsibilities in the performance of ethics consultation.
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Affiliation(s)
- Stuart G Finder
- Director, Center for Healthcare Ethics, Professor of Surgery and of Biomedical Sciences, Cedars-Sinai Medical Center, 116 North Robertson Blvd, Suite 900D, Los Angeles, CA, 90048, USA.
| | - Virginia L Bartlett
- Assistant Director, Center for Healthcare Ethics, Assistant Professor of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, USA
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Hutton CJ, Kay M, Round P, Barton C. Doctors' experiences when treating doctor-patients: a scoping review. BJGP Open 2023; 7:BJGPO.2023.0090. [PMID: 37479247 PMCID: PMC11176679 DOI: 10.3399/bjgpo.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/12/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND To work effectively, doctors need to look after themselves. They often delay seeking medical care for a range of reasons. Once they do, there is evidence that the doctors treating them ('treating doctors') can struggle to provide optimal care. AIM To examine existing literature on what is currently known about experiences for treating doctors, in particular GPs, when their patient is also a doctor. DESIGN & SETTING A scoping review of articles written in English. METHOD Using the JBI methodological framework for scoping reviews, five databases (MEDLINE, PsycINFO, CINAHL [Cumulative Index to Nursing & Allied Health], Google Scholar, and Scopus) were searched from the database start date until 31 December 2022. Qualitative and quantitative studies reporting the treating doctor's experience, guidelines for treating doctors, expert opinion articles, and editorials were included. Grey literature was considered, searching the first 10 pages of two Google searches. RESULTS Forty-eight articles from eight countries met inclusion criteria, of which 12 were research studies. The main areas of focus were as follows: affective responses, which included anxiety about being criticised, concern about upsetting the doctor-patient, and discomfort regarding the acknowledgement that doctors get sick; relational factors, which included boundary issues, over-identifying with the doctor-patient, treating them as a colleague rather than a patient, and role ambiguity; confidentiality, which incorporated both affective and relational aspects; and influence of medical culture and socialisation on dynamics between treating doctor and doctor-patient. These findings have been distilled into a list of key suggestions for the treating doctor. CONCLUSION Doctors can find treating doctor-patients anxiety-provoking and challenging. The sources of this discomfort are multifaceted, and more empirical research is needed to better understand and address the complex relationship between treating doctor and doctor-patient.
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Affiliation(s)
- Claire J Hutton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Margaret Kay
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Penny Round
- School of Curriculum Teaching and Inclusive Education, Faculty of Education, Monash University, Melbourne, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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3
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Constantino E, Spina T. Psychiatric Treatment of Medical Colleagues and Their Families: Potential Risks. J Psychiatr Pract 2023; 29:489-492. [PMID: 37948174 DOI: 10.1097/pra.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Clinicians treating "very important persons" face potential problems that can negatively impact the quality of care they provide. Mental health professionals face similar pressures, particularly when asked to treat a particular kind of patient who is a very important person: medical colleagues or their family members. The authors present 3 cases that exemplify possible risks associated with the psychiatric treatment of these individuals, including negative effects on the physician-patient relationship, lapses in patient confidentiality, and violations of medical ethics. Preventive and mitigative steps to avoid these pitfalls are discussed. Awareness of these issues when treating fellow physicians or their family members is an important consideration for any mental health clinician.
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Affiliation(s)
- Eduardo Constantino
- CONSTANTINO and SPINA: Department of Psychiatry and Behavioral Health, Stony Brook Medicine, Stony Brook, NY
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Avinger AM, McClary T, Dixon M, Pentz RD. Evaluation of Standard-of-Care Practices Among Physicians Who Treat Other Physicians: A Qualitative Study. JAMA Netw Open 2022; 5:e2236914. [PMID: 36255726 PMCID: PMC9579902 DOI: 10.1001/jamanetworkopen.2022.36914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Ethical discussions have suggested that physicians who treat other physicians may put their physician-patients at risk of receiving non-standard-of-care treatment, which may result in worse outcomes. This phenomenon occurs when a physician treats a fellow physician as a VIP (very important person), and is therefore known as VIP syndrome. It is important to assess physicians' perceptions when treating physician-patients. OBJECTIVE To determine whether the physicians treating other physicians have attitudes toward or act in ways that could place physician-patients at risk for VIP syndrome. DESIGN, SETTING, AND PARTICIPANTS This 2-part qualitative study was conducted from December 1, 2021, to February 28, 2022. Physicians who worked at a single comprehensive cancer center with experience treating other physicians were eligible to participate. Convenience sampling was used. Emails and flyers were sent out with study information, and if interested, physicians were able to schedule an interview. Of 24 physicians responding, 3 did not have experience treating other physicians, yielding a sample of 21 (88%), which was sufficient to reach a saturation of themes. After the initial structured interview of physicians, follow-up key informant interviews were performed. EXPOSURES The structured interview was developed on the basis of a literature review and focused on factors that may contribute to VIP syndrome. MAIN OUTCOMES AND MEASURES Participant responses to open-ended questions were qualitatively coded using standard multilevel semantic analysis to assess physician perceptions of treating fellow physicians. A series of Likert-scaled questions were used to identify potential contributing factors to VIP syndrome. RESULTS Twenty-one physicians (11 men [52%], 11 White [52%], and 15 [71%] younger than 49 years) participated. Although no physician interviewed stated that they altered their usual treatment plans, 11 (52%) agreed that their physician-patients tried to dictate their own care, and 17 (81%) believed that their physician-patients obtained privileges, such as use of medical knowledge to participate in in-depth discussions of care, ability to obtain and use the treating physicians personal contact information, and receiving faster access to care. Eleven respondents (52%) reported increased stress, and 12 (57%) experienced more pressure not to disappoint their physician-patients. CONCLUSIONS AND RELEVANCE The findings of this qualitative study suggest that when physicians treat other physicians, the physician-patients may obtain privileges unavailable to patients who are not physicians. Therefore, guidelines to help physicians navigate the complex relationships between themselves and their physician-patients are needed to ensure equitable outcomes between physician and nonphysician patients.
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Affiliation(s)
| | - Tekiah McClary
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Margie Dixon
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca D. Pentz
- Winship Cancer Institute, Emory University, Atlanta, Georgia
- Department of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia
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Rockwell H, Keller EJ, Tadros A, Newton I. VIP Patients in Interventional Radiology: Do Some Patients Deserve "Better" Care? Semin Intervent Radiol 2022; 39:454-458. [PMID: 36406034 PMCID: PMC9671680 DOI: 10.1055/s-0042-1757316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Helena Rockwell
- School of Medicine, University of California – San Diego, La Jolla, California
| | - Eric J. Keller
- Division of Interventional Radiology, Stanford University, Stanford, California
| | - Anthony Tadros
- Department of Radiology, University of California – San Diego, La Jolla, California
| | - Isabel Newton
- Department of Radiology, University of California – San Diego, La Jolla, California
- Division of Interventional Radiology, Veterans Administration San Diego Healthcare System, La Jolla, California
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Gangal A, Clark JA, Stoff B. Ethics of professional courtesy in cosmetic dermatology. J Am Acad Dermatol 2021; 87:253-254. [PMID: 34767828 DOI: 10.1016/j.jaad.2021.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/17/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Ameya Gangal
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Jason A Clark
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Clark Laser & Cosmetic Dermatology, Atlanta, Georgia
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Emory Center for Ethics, Emory University School of Medicine, Atlanta, Georgia
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Gomez J. A tale of two patients. Acad Emerg Med 2021; 28:1093-1094. [PMID: 34337818 DOI: 10.1111/acem.14350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Jason Gomez
- Stanford School of Medicine Stanford California USA
- Stanford Graduate School of Business Stanford California USA
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Kong HE, Stoff BK. Approach to VIPs during the COVID-19 pandemic and beyond. J Am Acad Dermatol 2020; 83:1231-1232. [PMID: 32652189 PMCID: PMC7342046 DOI: 10.1016/j.jaad.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
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D'Amico DJ. Observations on Ophthalmic Care and Surgery for Very Important People. JAMA Ophthalmol 2020; 138:1015-1016. [PMID: 32815983 DOI: 10.1001/jamaophthalmol.2020.2971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Donald J D'Amico
- Department of Ophthalmology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York
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Abstract
BACKGROUND Not all patients are considered equal. For patients who are considered to be "very important persons," care can be different from that of other patients with advantages of greater access to resources, special attention from staff, and options for luxurious hospital amenities. While very important person care is common and widely accepted by healthcare administration, it has negative implications for both very important person and non-very important person patients, supports care disparities and inequities, and can create serious ethical dilemmas for healthcare professionals. Very important person care can also result in negative care outcomes for its recipients. OBJECTIVE This article sought to explore the implications and ethical considerations of very important person care within the context of United States healthcare system, and integrate bioethical principles and American Nurses Association Code of Ethics for Nurses to influence recommendations for managing ethical dilemmas associated with very important person care. METHOD A synthesis of the literature on very important person care was undertaken for this article. ETHICAL CONSIDERATIONS Ethical conduct was considered and respected when performing the literature review, referencing sources, and establishing authorship. FINDINGS According to the published literature, very important person care bares both positive and negative implications for patients, and negative implications for nurses. Nurses are the most affected by the demands from their administrators to provide special care and attention to patients in the "very important person" category and their families. Very important person care can be disruptive, disorienting, challenging, and stressful to nurses. CONCLUSION While physicians and other healthcare professionals have commented on very important person care, limited work has been done in nursing. There have not been any empirical studies on very important person care. Therefore, in order to minimize the negative implications of very important person care, studies of this phenomenon are warranted. Exposing very important person care is important in the development of an ethical healthcare system. Moreover, understanding the ethical principles surrounding the concept of very important person care will empower nurses to effectively manage conflicts and ethical dilemmas that arise with very important person care.
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Affiliation(s)
- Jennifer T McIntosh
- College of Nursing and Public Health, Adelphi University, USA; Farmingdale State College, USA
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11
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Al Mulhim MA, Darling RG, Sarin R, Hart A, Kamal H, Al Hadhirah A, Voskanyan A, Hofmann L, Connor BA, Band RA, Jones J, Tubb R, Jackson R, Baez AA, Wasser E, Conley S, Lang W, Ciottone G. A dignitary medicine curriculum developed using a modified Delphi methodology. Int J Emerg Med 2020; 13:11. [PMID: 32085699 PMCID: PMC7035733 DOI: 10.1186/s12245-020-00270-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dignitary medicine is an emerging field of training that involves the specialized care of diplomats, heads of state, and other high-ranking officials. In an effort to provide guidance on training in this nascent field, we convened a panel of experts in dignitary medicine and using the Delphi methodology, created a consensus curriculum for training in dignitary medicine. METHODS A three-round Delphi consensus process was performed with 42 experts in the field of dignitary medicine. Predetermined scores were required for an aspect of the curriculum to advance to the next round. The scores on the final round were used to determine the components of the curriculum. Scores below the threshold to advance were dropped in the subsequent round. RESULTS Our panel had a high degree of agreement on the required skills needed to practice dignitary medicine, with active practice in a provider's baseline specialty, current board certification, and skills in emergency care and resuscitation being the highest rated skills dignitary medicine physicians need. Skills related to vascular and emergency ultrasound and quality improvement were rated the lowest in the Delphi analysis. No skills were dropped from consideration. CONCLUSIONS The results of our work can form the basis of formal fellowship training, continuing medical education, and publications in the field of dignitary medicine. It is clear that active medical practice and knowledge of resuscitation and emergency care are critical skills in this field, making emergency medicine physicians well suited to practicing dignitary medicine.
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Affiliation(s)
- Mobarak A Al Mulhim
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. .,Royal Clinics, Riyadh, Saudi Arabia.
| | | | - Ritu Sarin
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alex Hart
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | | | | | - Amalia Voskanyan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Lewis Hofmann
- White House Physician Emeritus, Shoreland, Washington, D.C., USA
| | - Bradley A Connor
- The New York Presbyterian Hospital, Cornell Campus, New York, USA
| | - Roger A Band
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - James Jones
- Medical Evaluation and Treatment Unit, WHMU, Washington D.C., USA
| | - Richard Tubb
- White House Physician Emeritus, Shoreland, Washington, D.C., USA
| | - Ronny Jackson
- The White House Medical Unit (WHMU), Washington, D.C., USA
| | - Amado Alejandro Baez
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, USA
| | - Edward Wasser
- Canada Protective Detail (PMPD), Royal Canadian Mounted Police (RCMP), Ottawa, Canada
| | - Sean Conley
- The White House Medical Unit (WHMU), Washington, D.C., USA
| | - William Lang
- The White House Medical Unit (WHMU), Washington, D.C., USA.,International Medicine, Inova Health System, Merrifield, USA
| | - Gregory Ciottone
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Al Mulhim MA, Darling RG, Kamal H, Voskanyan A, Ciottone G. Dignitary Medicine: A Novel Area of Medical Training. Cureus 2019; 11:e5962. [PMID: 31799098 PMCID: PMC6863586 DOI: 10.7759/cureus.5962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dignitary medicine (DM) involves the provision of healthcare to government leaders and other high-profile individuals collectively referred to as "dignitaries." Due to the unique circumstances around their lifestyle, dignitaries often receive suboptimal healthcare. We define the requisite skills needed to practice DM based on the available literature and provide a framework for training providers in these skills. A review of the English language medical literature focussing on adult subjects was performed, searching for terms such as "dignitary medicine," "VIP medicine," and "protective medicine." Literature was gathered from CINAHL, Google Scholar, PubMed, EBSCOHost, and San Bernardino County Library databases and then analyzed by experienced DM providers. A total of 23 relevant articles were eligible for review. No meta-analyses on the subject exist. We found that existing studies highlight skills in wellness, executive health, and protective medicine, which form the backbone of DM. The burgeoning field of DM encompasses several disciplines and skills. We strongly recommend a structured curriculum for the field of DM, focused on dignitary wellness, executive health, and protective medicine.
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Affiliation(s)
| | - Robert G Darling
- Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Hetaf Kamal
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Amalia Voskanyan
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Gregory Ciottone
- Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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Nakagawa K, Yellowlees PM. The Physician's Physician: The Role of the Psychiatrist in Helping Other Physicians and Promoting Wellness. Psychiatr Clin North Am 2019; 42:473-482. [PMID: 31358126 DOI: 10.1016/j.psc.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Psychiatrists have valuable training, knowledge, and experience to serve as champions for physician health. The prevalence of physician burnout, suicide, and depression negatively affects the health care system at a critical time when the country faces a physician shortage, increasing costs, and a push toward higher quality of care. Psychiatrists are in prime position to serve as the "Physician's Physician" and lead their organizations to increase awareness, build capacity, and drive cultural change. New leadership opportunities exist for psychiatrists, including the role of chief wellness officer, serving on physician well-being committees, and learning skills required to treat other physicians as patients.
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Affiliation(s)
- Keisuke Nakagawa
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Peter M Yellowlees
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA
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Abstract
Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The seventh edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession.
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Collins ME, Rum S, Wheeler J, Antman K, Brem H, Carrese J, Glennon M, Kahn J, Ohman EM, Jagsi R, Konrath S, Tovino S, Wright S, Sugarman J. Ethical Issues and Recommendations in Grateful Patient Fundraising and Philanthropy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1631-1637. [PMID: 30024472 PMCID: PMC6211779 DOI: 10.1097/acm.0000000000002365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Grateful patients provide substantial philanthropic funding for health care institutions, resulting in important societal benefits. Although grateful patient fundraising (GPFR) is widespread, it raises an array of ethical issues for patients, physicians, development professionals, and institutions. These issues have not been described comprehensively, and there is insufficient guidance to inform the ethical practice of GPFR. Consequently, the authors convened a "Summit on the Ethics of Grateful Patient Fundraising," with the goal of identifying primary ethical issues in GPFR and offering recommendations regarding how to manage them. Participants were 29 experts from across the United States who represented the perspectives of bioethics, clinical practice, development, law, patients, philanthropy, psychology, and regulatory compliance. Intensive discussions resulted in articulating ethical issues for physicians and other clinicians (discussions with patients about philanthropy; physician-initiated discussions; clinically vulnerable patients; conflicts of obligation and equity regarding physician's time, attention, and responsiveness and the provision of special services; and transparency and respecting donor intent) as well as for development officers and institutions (transparency in the development professional-donor relationship; impact on clinical care; confidentiality and privacy; conflicts of interest; institution-patient/donor relationship; concierge services for grateful patients; scientific merit and research integrity; transparency in use of philanthropic gifts; and institutional policies and training in responsible GPFR). While these recommendations promise to mitigate some of the ethical issues associated with GPFR, important next steps include conducting research on the ethical issues in GPFR, disseminating these recommendations, developing standardized training for clinicians regarding them, and revising them as warranted.
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Affiliation(s)
- Megan E. Collins
- M.E. Collins is assistant professor, Wilmer Eye Institute, Johns Hopkins University School of Medicine, and core faculty, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Steven Rum
- S. Rum is vice president for development and alumni relations, Fund for Johns Hopkins Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jane Wheeler
- J. Wheeler is director, Business Development and Communications, Fund for Johns Hopkins Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Antman
- K. Antman is provost, Boston University Medical Campus, and dean, Boston University School of Medicine, Boston, Massachusetts
| | - Henry Brem
- H. Brem is Harvey Cushing Professor of Neurosurgery, and director, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Carrese
- J. Carrese is professor of medicine, Johns Hopkins University School of Medicine, and core faculty, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Glennon
- M. Glennon is associate vice president, Fund for Johns Hopkins Medicine, Baltimore, Maryland
| | - Jeffrey Kahn
- J. Kahn is Andreas C. Dracopoulos Director, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
| | - E. Magnus Ohman
- E.M. Ohman is professor of medicine and vice chair, Department of Medicine–Development and Innovation, Duke University School of Medicine, Durham, North Carolina
| | - Reshma Jagsi
- R. Jagsi is professor of radiation oncology and director, Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Sara Konrath
- S. Konrath is associate professor of philanthropic studies, Lilly Family School of Philanthropy, Indiana University, Indianapolis, Indiana
| | - Stacey Tovino
- S. Tovino is Lehman Professor of Law and director, Health Law Program, William S. Boyd School of Law, University of Nevada–Las Vegas, Las Vegas, Nevada
| | - Scott Wright
- S. Wright is professor of medicine, Johns Hopkins University School of Medicine, and chief, General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Jeremy Sugarman
- J. Sugarman is Harvey M. Meyerhoff Professor of Bioethics and Medicine, Berman Institute of Bioethics, Johns Hopkins University, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, Halvorsen K, Harvey C, Toffoli L, Scott PA. Ethical elements in priority setting in nursing care: A scoping review. Int J Nurs Stud 2018; 88:25-42. [PMID: 30179768 DOI: 10.1016/j.ijnurstu.2018.08.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/04/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nurses are often responsible for the care of many patients at the same time and have to prioritise their daily nursing care activities. Prioritising the different assessed care needs and managing consequential conflicting expectations, challenges nurses' professional and moral values. OBJECTIVE To explore and illustrate the key aspects of the ethical elements of the prioritisation of nursing care and its consequences for nurses. DESIGN, DATA SOURCES AND METHODS A scoping review was used to analyse existing empirical research on the topics of priority setting, prioritisation and rationing in nursing care, including the related ethical issues. The selection of material was conducted in three stages: research identification using two data bases, CINAHL and MEDLINE. Out of 2024 citations 25 empirical research articles were analysed using inductive content analysis. RESULTS Nurses prioritised patient care or participated in the decision-making at the bedside and at unit, organisational and at societal levels. Bedside priority setting, the main concern of nurses, focused on patients' daily care needs, prioritising work by essential tasks and participating in priority setting for patients' access to care. Unit level priority setting focused on processes and decisions about bed allocation and fairness. Nurses participated in organisational and societal level priority setting through discussion about the priorities. Studies revealed priorities set by nurses include prioritisation between patient groups, patients having specific diseases, the severity of the patient's situation, age, and the perceived good that treatment and care brings to patients. The negative consequences of priority setting activity were nurses' moral distress, missed care, which impacts on both patient outcomes and nursing professional practice and quality of care compromise. CONCLUSIONS Analysis of the ethical elements, the causes, concerns and consequences of priority setting, need to be studied further to reveal the underlying causes of priority setting for nursing staff. Prioritising has been reported to be difficult for nurses. Therefore there is a need to study the elements and processes involved in order to determine what type of education and support nurses require to assist them in priority setting.
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Affiliation(s)
- Riitta Suhonen
- University of Turku, Department of Nursing Science, Turku University Hospital, and City of Turku, Welfare Division, Turku, Finland.
| | - Minna Stolt
- University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland.
| | | | - Ingibjörg Hjaltadottir
- University of Iceland, Clinical Nurse Specialist, University Hospital of Iceland, Iceland.
| | - Stavros Vryonides
- Cyprus University of Technology, School of Health Sciences, Department of Nursing, Limassol, Cyprus.
| | | | | | - Clare Harvey
- Central Queensland University Australia, School of Nursing, Midwifery and Social Sciences, Tertiary Education Division, Mackay, Australia.
| | - Luisa Toffoli
- School of Nursing and Midwifery, University of South Australia, Australia.
| | - P Anne Scott
- National University of Ireland Galway, Galway, Ireland.
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Cook JW, Dillmon M, Graff SL, Pentz RD, Srivastava R, Close JL. Caring for Colleagues and Loved Ones With Cancer. Am Soc Clin Oncol Educ Book 2018; 38:903-908. [PMID: 30231376 DOI: 10.1200/edbk_201451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Throughout the arc of a career in medicine, physicians are universally faced with the difficult decision of when to provide care for a colleague and when to refer to another physician. Gauging the magnitude of your relationship, both professionally and personally, and then weighing how to add the roles of physician and patient to your preexisting relationship is complex. We review and discuss care of family and colleagues, address ethical boundaries both firm and flexible, and explore the emotional weight of those relationships.
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Affiliation(s)
- John W Cook
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
| | - Melissa Dillmon
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
| | - Stephanie L Graff
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
| | - Rebecca D Pentz
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
| | - Ranjana Srivastava
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
| | - Julia L Close
- From the Winship Cancer Institute of Emory University, Atlanta, GA; Harbin Clinic LLC, Rome, GA; Sarah Cannon Cancer Institutes HCA Midwest Health, Overland Park, KS; Emory University School of Medicine, Atlanta, GA; Monash Medical Centre, Glen Waverley, Australia; University of Florida College of Medicine, Gainesville, FL
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Caring for VIPs in the emergency department: Are they VIPs or patients? Am J Emerg Med 2018; 36:895-896. [DOI: 10.1016/j.ajem.2017.09.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022] Open
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Arora G, Gibb TS, Bursch B. Maintaining quality of care for very influential patients. CLINICAL TEACHER 2018; 15:175-177. [DOI: 10.1111/tct.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gitanjli Arora
- USC Keck School of Medicine; Children's Hospital Los Angeles; Los Angeles California USA
| | - Tyler S Gibb
- Western Michigan University Homer Stryker M.D. School of Medicine; Kalamazoo Michigan USA
| | - Brenda Bursch
- David Geffen School of Medicine at UCLA; Psychiatry & Pediatrics Departments; Los Angeles California USA
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Allen-Dicker J, Auerbach A, Herzig SJ. Perceived Safety and Value of Inpatient "Very Important Person" Services. J Hosp Med 2017; 12:177-179. [PMID: 28272595 DOI: 10.12788/jhm.2701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Providing care to "very important person" (VIP) patients can pose unique moral and value-based challenges for providers. No studies have examined VIP services in the inpatient setting. Through a multi-institutional survey of hospitalists, we assessed physician viewpoints and behavior surrounding the care of VIP patients. A significant proportion of respondents reported feeling pressured by patients, family members, and hospital representatives to provide unnecessary care to VIP patients. Based on self-reported perceptions, as well as case-based questions, we also found that the VIP status of a patient may impact physician clinical decision-making related to unnecessary medical care. Additional studies to quantify the use of VIP services and its effect on cost, resource availability, and patient-specific outcomes are needed. Journal of Hospital Medicine 2017;12:177-179.
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Affiliation(s)
- Joshua Allen-Dicker
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Shoshana J Herzig
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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