Andis Robeznieks
AMA Wire
Originally published August 8, 2017
Here are two excerpts:
A lawsuit alleging Dr. Toms had not obtained informed consent was initiated by Shinal and her husband on Dec. 17, 2009. The brief notes that Shinal “did not assert that the harm was the result of negligence” and that “there is no contention” that Dr. Toms’ staff provided inaccurate information during the informed consent process.
A jury found for Dr. Toms. Shinal appealed and the Pennsylvania Superior Court affirmed the decision. The case was heard before the Pennsylvania Supreme Court in November 2016. The case was decided June 20.
According to Wecht, a key issue is “whether the trial court misapplied the common law and the MCARE Act when it instructed the jury that it could consider information provided to Mrs. Shinal by Dr. Toms' ‘qualified staff’ in deciding whether Dr. Toms obtained Mrs. Shinal's informed consent to aggressive brain surgery.”
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PAMED General Counsel Angela Boateng also weighed in.
“It was not uncommon for other qualified staff to assist a physician in providing the requisite information or answering follow-up questions a patient may have had. The Medical Practice Act and other professional regulations permitted this level of assistance,” she commented. “The patient’s ability to follow up with the physician or his qualified staff was usually aimed at promoting a patient’s understanding of the treatment or procedure to be completed. The court’s decision, however, has put an end to this practice.”
The article is here.
Showing posts with label Physicians. Show all posts
Showing posts with label Physicians. Show all posts
Tuesday, August 22, 2017
Wednesday, August 16, 2017
What Does Patient Autonomy Mean for Doctors and Drug Makers?
Christina Sandefur
The Conversation
Originally published July 26, 2017
Here is an excerpt:
Although Bateman-House fears that deferring to patients comes at the expense of physician autonomy, she also laments that physicians currently abuse the freedom they have, failing to spend enough time with their patients, which she says undermines a patient’s ability to make informed medical decisions.
Even if it’s true that physician consultations aren’t as thorough as they once were, patients today have better access to health care information than ever before. According to the Pew Research Center, two-thirds of U.S. adults have broadband internet in their homes, and 13 percent who lack it can access the internet through a smartphone. Pew reports that more than half of adult internet users go online to get information on medical conditions, 43 percent on treatments, and 16 percent on drug safety. Yet despite their desire to research these issues online, 70 percent still sought out additional information from a doctor or other professional.
In other words, people are making greater efforts to learn about health care on their own. True, not all such information on the internet is accurate. But encouraging patients to seek out information from multiple sources is a good thing. In fact, requiring government approval of treatments may lull patients into a false sense of security. As Connor Boyack, president of the Libertas Institute, points out, “Instead of doing their own due diligence and research, the overwhelming majority of people simply concern themselves with whether or not the FDA says a certain product is okay to use.” But blind reliance on a government bureaucracy is rarely a good idea.
The article can be found here.
The Conversation
Originally published July 26, 2017
Here is an excerpt:
Although Bateman-House fears that deferring to patients comes at the expense of physician autonomy, she also laments that physicians currently abuse the freedom they have, failing to spend enough time with their patients, which she says undermines a patient’s ability to make informed medical decisions.
Even if it’s true that physician consultations aren’t as thorough as they once were, patients today have better access to health care information than ever before. According to the Pew Research Center, two-thirds of U.S. adults have broadband internet in their homes, and 13 percent who lack it can access the internet through a smartphone. Pew reports that more than half of adult internet users go online to get information on medical conditions, 43 percent on treatments, and 16 percent on drug safety. Yet despite their desire to research these issues online, 70 percent still sought out additional information from a doctor or other professional.
In other words, people are making greater efforts to learn about health care on their own. True, not all such information on the internet is accurate. But encouraging patients to seek out information from multiple sources is a good thing. In fact, requiring government approval of treatments may lull patients into a false sense of security. As Connor Boyack, president of the Libertas Institute, points out, “Instead of doing their own due diligence and research, the overwhelming majority of people simply concern themselves with whether or not the FDA says a certain product is okay to use.” But blind reliance on a government bureaucracy is rarely a good idea.
The article can be found here.
Friday, August 4, 2017
Moral distress in physicians and nurses: Impact on professional quality of life and turnover
Austin, Cindy L.; Saylor, Robert; Finley, Phillip J.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Thursday, June 8, 2017
Shining Light on Conflicts of Interest
Craig Klugman
The American Journal of Bioethics
Volume 17, 2017 - Issue 6
Chimonas, DeVito and Rothman (2017) offer a descriptive target article that examines physicians' knowledge of and reaction to the Sunshine Act's Open Payments Database. This program is a federal computer repository of all payments and goods with a worth over $10 made from pharmaceutical companies and device manufacturers to physicians. Created under the 2010 Affordable Care Act, the goal of this database is to make the relationships between physicians and the medical drug/device industry more transparent. Such transparency is often touted as a solution to financial conflicts of interest (COI). A COI occurs when a person owes featly to more than one party. For example, physicians have fiduciary duties toward patients. At the same time, when physicians receive gifts or benefits from a pharmaceutical company, they are more likely to prescribe that company's products (Spurling et al. 2010). The gift creates a sense of a moral obligation toward the company. These two interests can be (but may not be) in conflict. Such arrangements can undermine a patient's trust with his/her physician, and more broadly, the public's trust of medicine.
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The idea is that if people are told about the conflict, then they can judge for themselves whether the provider is compromised and whether they wish to receive care from this person. The database exists with this intent—that transparency alone is enough. What is a patient to do with this information? Should patients avoid physicians who have conflicts? The decision is left in the patient's hands. Back in 2014, the Pharmaceutical Research and Manufacturers of America lobbying group expressed concern that the public would not understand the context of any payments or gifts to physicians (Castellani 2014).
The article is here.
The American Journal of Bioethics
Volume 17, 2017 - Issue 6
Chimonas, DeVito and Rothman (2017) offer a descriptive target article that examines physicians' knowledge of and reaction to the Sunshine Act's Open Payments Database. This program is a federal computer repository of all payments and goods with a worth over $10 made from pharmaceutical companies and device manufacturers to physicians. Created under the 2010 Affordable Care Act, the goal of this database is to make the relationships between physicians and the medical drug/device industry more transparent. Such transparency is often touted as a solution to financial conflicts of interest (COI). A COI occurs when a person owes featly to more than one party. For example, physicians have fiduciary duties toward patients. At the same time, when physicians receive gifts or benefits from a pharmaceutical company, they are more likely to prescribe that company's products (Spurling et al. 2010). The gift creates a sense of a moral obligation toward the company. These two interests can be (but may not be) in conflict. Such arrangements can undermine a patient's trust with his/her physician, and more broadly, the public's trust of medicine.
(cut)
The idea is that if people are told about the conflict, then they can judge for themselves whether the provider is compromised and whether they wish to receive care from this person. The database exists with this intent—that transparency alone is enough. What is a patient to do with this information? Should patients avoid physicians who have conflicts? The decision is left in the patient's hands. Back in 2014, the Pharmaceutical Research and Manufacturers of America lobbying group expressed concern that the public would not understand the context of any payments or gifts to physicians (Castellani 2014).
The article is here.
Saturday, May 20, 2017
Conflict of Interest and the Integrity of the Medical Profession
Allen S. Lichter
JAMA. 2017;317(17):1725-1726.
Physicians have a moral responsibility to patients; they are trusted to place the needs and interests of patients ahead of their own, free of unwarranted outside influences on their decisions. Those who have relationships that might be seen to influence their decisions and behaviors that may affect fulfilling their responsibilities to patients must be fully transparent about them. Two types of interactions and activities involving physicians are most relevant: (1) commercial or research relationships between a physician expert and a health care company designed to advance an idea or promote a product, and (2) various gifts, sponsored meals, and educational offerings that come directly or indirectly to physicians from these companies.
Whether these and other ties to industry are important is not a new issue for medicine. Considerations regarding the potential influence of commercial ties date back at least to the 1950s and 1960s. In 1991, Relman reminded physicians that they have “a unique opportunity to assume personal responsibility for important decisions that are not influenced by or subordinated to the purposes of third parties.” However, examples of potential subordination are easily found. There are reports of physicians who are paid handsomely to promote a drug or device, essentially serving as a company spokesperson; of investigators who have ownership in the company that stands to gain if the clinical trial is successful; and of clinical guideline panels that are dominated by experts with financial ties to companies whose products are relevant to the disease or condition at hand.
The article is here.
JAMA. 2017;317(17):1725-1726.
Physicians have a moral responsibility to patients; they are trusted to place the needs and interests of patients ahead of their own, free of unwarranted outside influences on their decisions. Those who have relationships that might be seen to influence their decisions and behaviors that may affect fulfilling their responsibilities to patients must be fully transparent about them. Two types of interactions and activities involving physicians are most relevant: (1) commercial or research relationships between a physician expert and a health care company designed to advance an idea or promote a product, and (2) various gifts, sponsored meals, and educational offerings that come directly or indirectly to physicians from these companies.
Whether these and other ties to industry are important is not a new issue for medicine. Considerations regarding the potential influence of commercial ties date back at least to the 1950s and 1960s. In 1991, Relman reminded physicians that they have “a unique opportunity to assume personal responsibility for important decisions that are not influenced by or subordinated to the purposes of third parties.” However, examples of potential subordination are easily found. There are reports of physicians who are paid handsomely to promote a drug or device, essentially serving as a company spokesperson; of investigators who have ownership in the company that stands to gain if the clinical trial is successful; and of clinical guideline panels that are dominated by experts with financial ties to companies whose products are relevant to the disease or condition at hand.
The article is here.
Wednesday, May 17, 2017
Where did Nazi doctors learn their ethics? From a textbook
Michael Cook
BioEdge.org
Originally posted April 29, 2017
German medicine under Hitler resulted in so many horrors – eugenics, human experimentation, forced sterilization, involuntary euthanasia, mass murder – that there is a temptation to say that “Nazi doctors had no ethics”.
However, according to an article in the Annals of Internal Medicine by Florian Bruns and Tessa Chelouche (from Germany and Israel respectively), this was not the case at all. In fact, medical ethics was an important part of the medical curriculum between 1939 and 1945. Nazi officials established lectureships in every medical school in Germany for a subject called “Medical Law and Professional Studies” (MLPS).
There was no lack of ethics. It was just the wrong kind of ethics.
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It is important to realize that ethical reasoning can be corrupted and that teaching ethics is, in itself, no guarantee of the moral integrity of physicians.
The article is here.
BioEdge.org
Originally posted April 29, 2017
German medicine under Hitler resulted in so many horrors – eugenics, human experimentation, forced sterilization, involuntary euthanasia, mass murder – that there is a temptation to say that “Nazi doctors had no ethics”.
However, according to an article in the Annals of Internal Medicine by Florian Bruns and Tessa Chelouche (from Germany and Israel respectively), this was not the case at all. In fact, medical ethics was an important part of the medical curriculum between 1939 and 1945. Nazi officials established lectureships in every medical school in Germany for a subject called “Medical Law and Professional Studies” (MLPS).
There was no lack of ethics. It was just the wrong kind of ethics.
(cut)
It is important to realize that ethical reasoning can be corrupted and that teaching ethics is, in itself, no guarantee of the moral integrity of physicians.
The article is here.
Friday, May 12, 2017
Physicians, Not Conscripts — Conscientious Objection in Health Care
Ronit Y. Stahl and Ezekiel J. Emanuel
N Engl J Med 2017; 376:1380-1385
“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.
The article is here, and you need a subscription.
Here is an excerpt:
Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).
Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.
N Engl J Med 2017; 376:1380-1385
“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients, and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.
The article is here, and you need a subscription.
Here is an excerpt:
Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).
Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.
Wednesday, March 22, 2017
The Case of Dr. Oz: Ethics, Evidence, and Does Professional Self-Regulation Work?
Jon C. Tilburt, Megan Allyse, and Frederic W. Hafferty
AMA Journal of Ethics. February 2017, Volume 19, Number 2: 199-206.
Abstract
Dr. Mehmet Oz is widely known not just as a successful media personality donning the title “America’s Doctor®,” but, we suggest, also as a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the issue of whether the medical profession can effectively self-regulate at all. It also raises concern that the medical profession’s self-regulation might be selectively activated, perhaps only when the subject of professional censure has achieved a level of public visibility. We argue here that the medical profession must look at itself with a healthy dose of self-doubt about whether it has sufficient knowledge of or handle on the less visible Dr. “Ozes” quietly operating under the profession’s presumptive endorsement.
The article is here.
AMA Journal of Ethics. February 2017, Volume 19, Number 2: 199-206.
Abstract
Dr. Mehmet Oz is widely known not just as a successful media personality donning the title “America’s Doctor®,” but, we suggest, also as a physician visibly out of step with his profession. A recent, unsuccessful attempt to censure Dr. Oz raises the issue of whether the medical profession can effectively self-regulate at all. It also raises concern that the medical profession’s self-regulation might be selectively activated, perhaps only when the subject of professional censure has achieved a level of public visibility. We argue here that the medical profession must look at itself with a healthy dose of self-doubt about whether it has sufficient knowledge of or handle on the less visible Dr. “Ozes” quietly operating under the profession’s presumptive endorsement.
The article is here.
Thursday, March 9, 2017
Florida Doctors May Discuss Guns With Patients, Court Rules
Lizette Alvarez
The New York Times
Originally posted February
Here is an excerpt:
A federal appeals court cleared the way on Thursday for Florida doctors to talk to their patients about gun safety, overturning a 2011 law that pitted medical providers against the state's powerful gun lobby.
In its 10-to-1 ruling, the full panel of the United States Circuit Court of Appeals for the 11th Circuit concluded that doctors could not be threatened with losing their license for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech.
"Florida does not have carte blanche to restrict the speech of doctors and medical professionals on a certain subject without satisfying the demands of heightened scrutiny," the majority wrote in its decision. In its lawsuit, the medical community argued that questions about gun storage were crucial to public health because of the relationship between firearms and both the suicide rate and the gun-related deaths of children.
A number of doctors and medical organizations sued Florida in a case that came to be known as Docs v. Glocks, after the popular handgun.
The article is here.
The New York Times
Originally posted February
Here is an excerpt:
A federal appeals court cleared the way on Thursday for Florida doctors to talk to their patients about gun safety, overturning a 2011 law that pitted medical providers against the state's powerful gun lobby.
In its 10-to-1 ruling, the full panel of the United States Circuit Court of Appeals for the 11th Circuit concluded that doctors could not be threatened with losing their license for asking patients if they owned guns and for discussing gun safety because to do so would violate their free speech.
"Florida does not have carte blanche to restrict the speech of doctors and medical professionals on a certain subject without satisfying the demands of heightened scrutiny," the majority wrote in its decision. In its lawsuit, the medical community argued that questions about gun storage were crucial to public health because of the relationship between firearms and both the suicide rate and the gun-related deaths of children.
A number of doctors and medical organizations sued Florida in a case that came to be known as Docs v. Glocks, after the popular handgun.
The article is here.
Tuesday, January 31, 2017
Why doctors are leery about seeking mental health care for themselves
By Nathaniel P. Morris
The Washington Post
Originally published January 7, 2016
A survey of 2,000 U.S. physicians released in September found that roughly half believed they had met criteria for a mental health disorder in the past but had not sought treatment. The doctors listed a number of reasons they had shunned care, including worries that they’d be stigmatized and an inability to find the time.
But they also voiced a troubling reason for avoiding treatment: medical licensing applications.
After graduating from medical school, doctors must complete residency training and apply for state medical licenses to practice medicine. According to a study that appeared in 2008, about 90 percent of state medical boards have licensing forms that include questions about an applicant’s mental health.
Such questions are intended to protect the public, based on the idea that impaired or distressed physicians could endanger patients. A physician having hallucinations, for example, might not be able to focus or practice safely.
The article is here.
The Washington Post
Originally published January 7, 2016
A survey of 2,000 U.S. physicians released in September found that roughly half believed they had met criteria for a mental health disorder in the past but had not sought treatment. The doctors listed a number of reasons they had shunned care, including worries that they’d be stigmatized and an inability to find the time.
But they also voiced a troubling reason for avoiding treatment: medical licensing applications.
After graduating from medical school, doctors must complete residency training and apply for state medical licenses to practice medicine. According to a study that appeared in 2008, about 90 percent of state medical boards have licensing forms that include questions about an applicant’s mental health.
Such questions are intended to protect the public, based on the idea that impaired or distressed physicians could endanger patients. A physician having hallucinations, for example, might not be able to focus or practice safely.
The article is here.
Monday, January 9, 2017
Medical students need to learn the potent medicine of empathy
By Wolfgang Gilliar
STAT News
Originally published September 29, 2016
Here is an excerpt:
How does empathy do this? A patient who feels emotionally connected to his or her doctor is more likely to disclose important medical information and to follow the doctor’s advice. That connection can serve as the basis for true teamwork, with the patient working proactively with the medical team to improve health. Simply put, patients who feel cared about feel better and do better.
There’s also great promise in osteopathic medicine, which couples traditional medical interventions with skilled, specialized, hands-on treatments for the body’s complex system of nerves, muscles, and bones. “Healing touch” isn’t just a metaphor. This simple physical action evokes trust in patients.
Without empathy, doctors run the risk of alienating their patients. The relationship can become one-sided, with the physician simply dictating treatments and the patient following orders. Core emotional needs can be ignored, leading patients to feel lonely and downtrodden. And that deterioration of mood can make it less likely that they will experience positive outcomes from treatment.
The article is here.
STAT News
Originally published September 29, 2016
Here is an excerpt:
How does empathy do this? A patient who feels emotionally connected to his or her doctor is more likely to disclose important medical information and to follow the doctor’s advice. That connection can serve as the basis for true teamwork, with the patient working proactively with the medical team to improve health. Simply put, patients who feel cared about feel better and do better.
There’s also great promise in osteopathic medicine, which couples traditional medical interventions with skilled, specialized, hands-on treatments for the body’s complex system of nerves, muscles, and bones. “Healing touch” isn’t just a metaphor. This simple physical action evokes trust in patients.
Without empathy, doctors run the risk of alienating their patients. The relationship can become one-sided, with the physician simply dictating treatments and the patient following orders. Core emotional needs can be ignored, leading patients to feel lonely and downtrodden. And that deterioration of mood can make it less likely that they will experience positive outcomes from treatment.
The article is here.
Wednesday, November 23, 2016
Moral Distress in Physicians and Nurses: Impact on Professional Quality of Life and Turnover.
C. L. Austin, R. Saylor, and P. J. Finley
Psychological Trauma: Theory, Research, Practice, and Policy, 2016
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Psychological Trauma: Theory, Research, Practice, and Policy, 2016
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Sunday, August 21, 2016
Professing the Values of Medicine The Modernized AMA Code of Medical Ethics
Brotherton S, Kao A, Crigger BJ.
JAMA. Published online July 14, 2016.
doi:10.1001/jama.2016.9752
The word profession is derived from the Latin word that means “to declare openly.” On June 13, 2016, the first comprehensive update of the AMA Code of Medical Ethics in more than 50 years was adopted at the annual meeting of the American Medical Association (AMA). By so doing, physician delegates attending the meeting, who represent every state and nearly every specialty, publicly professed to uphold the values that are the underpinning of the ethical practice of medicine in service to patients and the public.
The AMA Code was created in 1847 as a national code of ethics for physicians, the first of its kind for any profession anywhere in the world.1 Since its inception, the AMA Code has been a living document that has evolved and expanded as medicine and its social environment have changed. By the time the AMA Council on Ethical and Judicial Affairs embarked on a systematic review of the AMA Code in 2008, it had come to encompass 220 separate opinions or ethics guidance for physicians on topics ranging from abortion to xenotransplantation. The AMA Code, over the years, became more fragmented and unwieldy. Opinions on individual topics were difficult to find; lacked a common narrative structure, which meant the underlying value motivating the guidance was not readily apparent; and were not always consistent in the guidance they offered or language they used.
The article is here.
JAMA. Published online July 14, 2016.
doi:10.1001/jama.2016.9752
The word profession is derived from the Latin word that means “to declare openly.” On June 13, 2016, the first comprehensive update of the AMA Code of Medical Ethics in more than 50 years was adopted at the annual meeting of the American Medical Association (AMA). By so doing, physician delegates attending the meeting, who represent every state and nearly every specialty, publicly professed to uphold the values that are the underpinning of the ethical practice of medicine in service to patients and the public.
The AMA Code was created in 1847 as a national code of ethics for physicians, the first of its kind for any profession anywhere in the world.1 Since its inception, the AMA Code has been a living document that has evolved and expanded as medicine and its social environment have changed. By the time the AMA Council on Ethical and Judicial Affairs embarked on a systematic review of the AMA Code in 2008, it had come to encompass 220 separate opinions or ethics guidance for physicians on topics ranging from abortion to xenotransplantation. The AMA Code, over the years, became more fragmented and unwieldy. Opinions on individual topics were difficult to find; lacked a common narrative structure, which meant the underlying value motivating the guidance was not readily apparent; and were not always consistent in the guidance they offered or language they used.
The article is here.
Saturday, July 30, 2016
Sexual abuse by doctors sometimes goes unpunished
Associated Press
Originally published July 6, 2016
Sexual abuse by doctors against patients is surprisingly widespread, yet the fragmented medical oversight system shrouds offenders' actions in secrecy and allows many to continue to treat patients, an investigation by The Atlanta Journal-Constitution has found.
The AJC obtained and analyzed more than 100,000 disciplinary orders against doctors since 1999. Among those, the newspaper identified more than 3,100 doctors sanctioned after being accused of sexual misconduct. More than 2,400 of the doctors had violations involving patients. Of those, half still have active medical licenses today, the newspaper found.
These cases represent only a fraction of incidences in which doctors have been accused of sexually abusing patients. Many remain obscured, the newspaper said, because state regulators and hospitals sometimes handle sexual misconduct cases in secret. Also, some public records are so vaguely worded that patients would not be aware that a sexual offense occurred.
The article is here.
Originally published July 6, 2016
Sexual abuse by doctors against patients is surprisingly widespread, yet the fragmented medical oversight system shrouds offenders' actions in secrecy and allows many to continue to treat patients, an investigation by The Atlanta Journal-Constitution has found.
The AJC obtained and analyzed more than 100,000 disciplinary orders against doctors since 1999. Among those, the newspaper identified more than 3,100 doctors sanctioned after being accused of sexual misconduct. More than 2,400 of the doctors had violations involving patients. Of those, half still have active medical licenses today, the newspaper found.
These cases represent only a fraction of incidences in which doctors have been accused of sexually abusing patients. Many remain obscured, the newspaper said, because state regulators and hospitals sometimes handle sexual misconduct cases in secret. Also, some public records are so vaguely worded that patients would not be aware that a sexual offense occurred.
The article is here.
Friday, July 29, 2016
When Doctors Have Conflicts of Interest
By Mikkael A. Sekeres
The New York Times - Well Blog
Originally posted June 29, 2016
Here is an excerpt:
What if, instead, the drug for which she provided advice is already commercially available. How much is her likelihood of prescribing this medication – what we call a conflict of commitment – influenced by her having been given an honorarium by the manufacturer for her advice about this or another drug made by the same company?
We know already that doctors are influenced in their prescribing patterns even by tchotchkes like pens or free lunches. One recent study of almost 280,000 physicians who received over 63,000 payments, most of which were in the form of free meals worth under $20, showed that these doctors were more likely to prescribe the blood pressure, cholesterol or antidepressant medication promoted as part of that meal than other medications in the same class of drugs. Are these incentives really enough to encroach on our sworn obligation to do what’s best for our patients, irrespective of outside influences? Perhaps, and that’s the reason many hospitals ban them.
In both scenarios the doctor should, at the very least, have to disclose the conflict to patients, either on a website, where patients could easily view it, or by informing them directly, as my mother-in-law’s doctor did to her.
The article is here.
The New York Times - Well Blog
Originally posted June 29, 2016
Here is an excerpt:
What if, instead, the drug for which she provided advice is already commercially available. How much is her likelihood of prescribing this medication – what we call a conflict of commitment – influenced by her having been given an honorarium by the manufacturer for her advice about this or another drug made by the same company?
We know already that doctors are influenced in their prescribing patterns even by tchotchkes like pens or free lunches. One recent study of almost 280,000 physicians who received over 63,000 payments, most of which were in the form of free meals worth under $20, showed that these doctors were more likely to prescribe the blood pressure, cholesterol or antidepressant medication promoted as part of that meal than other medications in the same class of drugs. Are these incentives really enough to encroach on our sworn obligation to do what’s best for our patients, irrespective of outside influences? Perhaps, and that’s the reason many hospitals ban them.
In both scenarios the doctor should, at the very least, have to disclose the conflict to patients, either on a website, where patients could easily view it, or by informing them directly, as my mother-in-law’s doctor did to her.
The article is here.
Doctors disagree about the ethics of treating friends and family
By Elisabeth Tracey
The Pulse
Originally published July 1, 2016
Here is an excerpt:
Gold says the guidelines are in place for good reason. One concern is that a physician may have inappropriate emotional investment in the care of a friend or family member.
"It may cloud your ability to make a good judgment, so you might treat them differently than you would treat a patient in your office," Gold says. "For example you might order extra tests for the family member that you wouldn't order for someone else."
Physicians may also avoid broaching uncomfortable topics with someone they know personally.
"Sometimes we're talking about sensitive issues," says Gold. "If someone has a sexually transmitted disease, it's very awkward with a family member to go into a lot of detail with them... even though with a patient you would have those discussions."
The article is here.
The Pulse
Originally published July 1, 2016
Here is an excerpt:
Gold says the guidelines are in place for good reason. One concern is that a physician may have inappropriate emotional investment in the care of a friend or family member.
"It may cloud your ability to make a good judgment, so you might treat them differently than you would treat a patient in your office," Gold says. "For example you might order extra tests for the family member that you wouldn't order for someone else."
Physicians may also avoid broaching uncomfortable topics with someone they know personally.
"Sometimes we're talking about sensitive issues," says Gold. "If someone has a sexually transmitted disease, it's very awkward with a family member to go into a lot of detail with them... even though with a patient you would have those discussions."
The article is here.
Thursday, June 30, 2016
State's top physician endorses opioid education mandate
By Rich Lord
Pittsburgh Post-Gazette
Originally posted June 8, 2016
Pennsylvania’s top physician said today that legislation compelling most doctors to take refresher courses in proper narcotic prescribing won’t overburden her colleagues in medicine -- and could help to counter the opioid and heroin epidemic.
“The bill that’s being discussed would be requirements for two hours of opioid education,” said Physician General Rachel Levine. “But it would also count toward [every doctor’s] quality and safety [education] requirement.”
Some doctors have said they don’t want to be told which continuing education courses to take. “But I think that there are sometimes topics that are so necessary to get updated on that all physicians should get updated,” Dr. Levine said. Opioid prescribing is one such topic, she said, “because of the very serious nature of the epidemic.”
The article is here.
Pittsburgh Post-Gazette
Originally posted June 8, 2016
Pennsylvania’s top physician said today that legislation compelling most doctors to take refresher courses in proper narcotic prescribing won’t overburden her colleagues in medicine -- and could help to counter the opioid and heroin epidemic.
“The bill that’s being discussed would be requirements for two hours of opioid education,” said Physician General Rachel Levine. “But it would also count toward [every doctor’s] quality and safety [education] requirement.”
Some doctors have said they don’t want to be told which continuing education courses to take. “But I think that there are sometimes topics that are so necessary to get updated on that all physicians should get updated,” Dr. Levine said. Opioid prescribing is one such topic, she said, “because of the very serious nature of the epidemic.”
The article is here.
When regulators close a 'pill mill,' patients sometimes turn to heroin
By Rich Lord
Pittsburgh Post-Gazette
Originally published May 25, 2016
Here is an excerpt:
In late 2013, Maryland launched its prescription drug monitoring program, allowing — but not requiring — doctors to access a database to see the drug histories of their patients. Nearly every state has such a system, designed to thwart people who seek drugs from multiple doctors. Some state medical boards use the data to flag physicians whose prescribing goes out of bounds.
Maryland’s board, though, can’t tap into the data “without going through major legal hoops,” Dr. Singh said. Physician groups, he said, have opposed efforts to ease access, because they fear “over-policing.”
Maryland has not adopted official opioid prescribing guidelines, as some states have.
The article is here.
Pittsburgh Post-Gazette
Originally published May 25, 2016
Here is an excerpt:
In late 2013, Maryland launched its prescription drug monitoring program, allowing — but not requiring — doctors to access a database to see the drug histories of their patients. Nearly every state has such a system, designed to thwart people who seek drugs from multiple doctors. Some state medical boards use the data to flag physicians whose prescribing goes out of bounds.
Maryland’s board, though, can’t tap into the data “without going through major legal hoops,” Dr. Singh said. Physician groups, he said, have opposed efforts to ease access, because they fear “over-policing.”
Maryland has not adopted official opioid prescribing guidelines, as some states have.
The article is here.
Thursday, May 19, 2016
FDA Reconsiders Training Requirement for Painkillers
BY Matthew Perrone
AP HEALTH WRITER
Originally published April 29, 2016
The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents.
The review comes as regulators disclosed that the number of doctors who completed voluntary training programs is less than half that targeted by the agency.
A panel of FDA advisers meets next week to review risk-management plans put in place nearly four years ago to reduce misuse and abuse of long-acting painkillers, powerful opioid drugs at the center of a national wave of abuse and death.
The article is here.
AP HEALTH WRITER
Originally published April 29, 2016
The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents.
The review comes as regulators disclosed that the number of doctors who completed voluntary training programs is less than half that targeted by the agency.
A panel of FDA advisers meets next week to review risk-management plans put in place nearly four years ago to reduce misuse and abuse of long-acting painkillers, powerful opioid drugs at the center of a national wave of abuse and death.
The article is here.
Wednesday, February 17, 2016
Complaints about doctors rarely lead to formal discipline
By Holly Moore
CBC News
Originally posted January 29, 2016
Nearly 8,000 Canadians filed a complaint about a physician last year, but on average only about 54 doctors were formally disciplined in each of the past 15 years. Of those complaints, just over half were determined to require no further action.
Historical data examined by CBC News found cases of 817 physicians that resulted in formal discipline, which is the only part of the disciplinary process for colleges of physicians and surgeons that is consistently made public across Canada.
"That number's not anywhere near what's actually happening. Those are the ones you could get to," said Ann Van Regan, a volunteer responder with TELL (Therapy Exploitation Link Line), a network of survivors of sex abuse by physicians and psychotherapists. "They say they're taking it seriously, but their actions show that they are not."
The article is here.
CBC News
Originally posted January 29, 2016
Nearly 8,000 Canadians filed a complaint about a physician last year, but on average only about 54 doctors were formally disciplined in each of the past 15 years. Of those complaints, just over half were determined to require no further action.
Historical data examined by CBC News found cases of 817 physicians that resulted in formal discipline, which is the only part of the disciplinary process for colleges of physicians and surgeons that is consistently made public across Canada.
"That number's not anywhere near what's actually happening. Those are the ones you could get to," said Ann Van Regan, a volunteer responder with TELL (Therapy Exploitation Link Line), a network of survivors of sex abuse by physicians and psychotherapists. "They say they're taking it seriously, but their actions show that they are not."
The article is here.
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