Believing in Overcoming Cognitive Biases

T. S. Doherty & A. E. Carroll

AMA J Ethics. 2020;22(9):E773-778. 

doi: 10.1001/amajethics.2020.773.

Abstract

Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error. Learning effective debiasing strategies and cultivating awareness of confirmation, anchoring, and outcomes biases and the affect heuristic, among others, and their effects on clinical decision making should be prioritized in all stages of education.

Here is an excerpt:

The practice of reflection reinforces behaviors that reduce bias in complex situations. A 2016 systematic review of cognitive intervention studies found that guided reflection interventions were associated with the most consistent success in improving diagnostic reasoning. A guided reflection intervention involves searching for and being open to alternative diagnoses and willingness to engage in thoughtful and effortful reasoning and reflection on one’s own conclusions, all with supportive feedback or challenge from a mentor.

The same review suggests that cognitive forcing strategies may also have some success in improving diagnostic outcomes. These strategies involve conscious consideration of alternative diagnoses other than those that come intuitively. One example involves reading radiographs in the emergency department. According to studies, a common pitfall among inexperienced clinicians in such a situation is to call off the search once a positive finding has been noticed, which often leads to other abnormalities (eg, second fractures) being overlooked. Thus, the forcing strategy in this situation would be to continue a search even after an initial fracture has been detected.

The article is here.

Small Victories: Texas social workers will no longer be allowed to discriminate against LGBTQ Texans and people with disabilities

Edgar Walters

Texas Tribune

Originally posted 27 Oct 20

After backlash from lawmakers and advocates, a state board voted Tuesday to undo a rule change that would have allowed social workers to turn away clients who are LGBTQ or have a disability.

The Texas Behavioral Health Executive Council voted unanimously to restore protections for LGBTQ and disabled clients to Texas social workers’ code of conduct just two weeks after removing them.

Gloria Canseco, who was appointed by Gov. Greg Abbott to lead the behavioral health council, expressed regret that the previous rule change was “perceived as hostile to the LGBTQ+ community or to disabled persons.”

“At every opportunity our intent is to prohibit discrimination against any person for any reason,” she said.

Abbott's office recommended earlier this month that the board strip three categories from a code of conduct that establishes when a social worker may refuse to serve someone.

The info is here.

Congratulations to all who help right a wrong in the mental health profession.

Professional Psychology: Collection Agencies, Confidentiality, Records, Treatment, and Staff Supervision in New Jersey

SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
DOCKET NO. A-4975-17T3

In the Matter of the Suspension or Revocation of the License of L. Barry Helfmann, Psy.D.

Here are two excerpts:

The complaint included five counts. It alleged Dr. Helfmann failed to do the following: take reasonable measures to protect confidentiality of the Partnership's patients' private health information; maintain permanent records that accurately reflected patient contact for treatment purposes; maintain records of professional quality; timely release records requested by a patient; and properly instruct and supervise temporary staff concerning patient confidentiality and record maintenance. The Attorney General sought sanctions under the UEA.

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The regulation is clear. The doctor's argument to the contrary, that a psychologist could somehow confuse his collection attorney with a patient's authorized representative, is refuted by the regulation's plain language as well as consideration of its entire context. The doctor's argument is without sufficient merit to warrant further discussion. R. 2:11-3(e)(1)(E).

We find nothing arbitrary about the Board's rejection of Dr. Helfmann's argument that he violated no rule or regulation because he relied on the advice of counsel in providing the Partnership's collection attorney with patients' confidential information. His assertion is contrary to the sworn testimony of the collection attorney who was deposed, as distinguished from another collection attorney with whom the doctor spoke in the distant past. The latter attorney's purported statement that confidential information might be necessary to resolve a patient's outstanding fee does not consider, let alone resolve, the propriety of a psychologist releasing such information in the face of clear statutory and regulatory prohibitions.

The Board found that Dr. Helfmann, not his collection attorneys, was charged with the professional responsibility of preserving his patients' confidential information. Perhaps the doctor's argument that he relied on the advice of counsel would have had greater appeal had he asked for a legal opinion on providing confidential patient information to collection attorneys in view of the psychologist-patient privilege and a specific regulatory prohibition against doing so absent a statutory or traditional exception. That the Board found unpersuasive Dr. Helfmann's hearsay testimony about what attorneys told him years ago is hardly arbitrary and capricious, considering the Partnership's current collection attorney's testimony and Dr. Helfmann's statutory and regulatory obligations to preserve confidentiality.

The decision is here.

Managing mental health challenges faced by healthcare workers during COVID-19 pandemic

Greenberg N., & others
BMJ 2020; 368 :m1211

Here is an excerpt:

Moral injury

Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.1 Unlike formal mental health conditions such as depression or post-traumatic stress disorder, moral injury is not a mental illness. But those who develop moral injuries are likely to experience negative thoughts about themselves or others (for example, “I am a terrible person” or “My bosses don’t care about people’s lives”) as well as intense feelings of shame, guilt, or disgust. These symptoms can contribute to the development of mental health difficulties, including depression, post-traumatic stress disorder, and even suicidal ideation. Equally, some people who have to contend with significant challenges, moral or traumatic, experience a degree of post-traumatic growth,3 a term used to describe a bolstering of psychological resilience, esteem, outlook, and values after exposure to highly challenging situations. Whether someone develops a psychological injury or experiences psychological growth is likely to be influenced by the way that they are supported before, during, and after a challenging incident.

Moral injury has already been described in medical students, who report great difficulty coping with working in prehospital and emergency care,4 where they were exposed to trauma that they felt unprepared for. This may be similar to the unprecedented nature of the challenges healthcare staff are currently facing. In the UK, most NHS staff may have felt, with some justification, that with all its faults, the NHS gives the sickest people the greatest chance of recovery. As such, staff should and usually do feel that it is something to be proud of.

The huge current effort to ensure adequate staffing and resources may be successful, but it looks likely that during the covid-19 outbreak many healthcare workers will encounter situations where they cannot say to a grieving relative, “We did all we could” but only, “We did our best with the staff and resources available, but it wasn’t enough.” That is the seed of a moral injury. Not all staff members will be adversely affected by the challenges ahead (table 1) but no one is invulnerable, and some healthcare workers will hurt, perhaps for a long time, unless we begin now to prepare and support our staff.

The info is here.

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

K. Schuler & D. Stulberg
AMA J Ethics. 2020;22(3):E239-247.
doi: 10.1001/amajethics.2020.239.

Abstract

Mission statements communicate health care organizations’ fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities.

Ethics, Mission, Standard of Care

Mission statements have long been used to communicate an organization’s values, priorities, and goals; serve as a moral compass for an organization; guide institutional decision making; and align efforts of employees. They can also be seen as advertising to prospective patients and employees. Although health care organizations’ mission statements serve these beneficial purposes, ethical questions (especially about business practices seen as motivating profit by rewarding underutilization) arise when mission implementation conflicts with acting in the best interests of patients. Ethical questions also arise when religiously affiliated organizations deny clinically indicated care in order to uphold their religiously based mission. For example, a Catholic organization’s mission statement might include phrases such as “faithful,” “honoring our sponsor’s spirit,” or “promoting reverence for life” and likely accords the Ethical and Religious Directives for Catholic Health Care Services, which Catholic organizations’ clinicians are required to follow as a condition of employment or privileges.

When strictly followed, these directives restrict health care service delivery, such that patients—particularly those seeking contraception, pregnancy termination, miscarriage management, end-of-life care, or other services perceived as conflicting with Catholic teaching—are not given the standard of care. Federal and state laws protect conscience rights of organizations, allowing them to refuse to provide services that conflict with the deeply held beliefs and values that drive their mission.6 Recognizing the potential for conflict between mission statements and patients’ autonomy or best interests, we maintain that health care organizations have fundamental ethical and professional obligations to patients that should not be superseded by a mission statement.

The info is here.

Can expert bias be reduced in medical guidelines?

Sheldon Greenfield
BMJ 2019; 367
https://doi.org/10.1136/bmj.l6882 

Here are two excerpts:

Despite robust study designs, even double blind randomised controlled trials can be subject to subtle forms of bias. This can be because of the financial conflicts of interest of the authors, intellectual or disciplinary based opinions, pressure on researchers from sponsors, or conflicting values. For example, some researchers may favour mortality over quality of life as a primary outcome, demonstrating a value conflict. The quality of evidence is often uneven and can include underappreciated sources of bias. This makes interpreting the evidence difficult, which results in guideline developers turning to “experts” to translate it into clinical practice recommendations.

Can we be confident that these experts are objective and free of bias? A 2011 Institute of Medicine (now known as the National Academy of Medicine) report1 challenged the assumption of objectivity among guideline development experts.

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The science that supports clinical medicine is constantly evolving. The pace of that evolution is increasing.

There is an urgent imperative to generate and update accurate, unbiased, clinical practice guidelines. So, what can we do now? I have two suggestions.

Firstly, the public, which may include physicians, nurses, and other healthcare providers dependent on guidelines, should advocate for organisations like the ECRI Institute and its international counterparts to be supported and looked to for setting standards.

Secondly, we should continue to examine the details and principles of “shared decision making” and other initiatives like it, so that doctors and patients can be as clear as possible in the face of uncertain evidence about medical treatments and recommendations.

It is an uphill battle, but one worth fighting.

What Clinical Ethics Can Learn From Decision Science

Michele C. Gornick and Brian J. Zikmund-Fisher
AMA J Ethics. 2019;21(10):E906-912.
doi: 10.1001/amajethics.2019.906.

Abstract

Many components of decision science are relevant to clinical ethics practice. Decision science encourages thoughtful definition of options, clarification of information needs, and acknowledgement of the heterogeneity of people’s experiences and underlying values. Attention to decision-making processes reminds participants in consultations that how decisions are made and how information is provided can change a choice. Decision science also helps reveal affective forecasting errors (errors in predictions about how one will feel in a future situation) that happen when people consider possible future health states and suggests strategies for correcting these and other kinds of biases. Implementation of decision science innovations is not always feasible or appropriate in ethics consultations, but their uses increase the likelihood that an ethics consultation process will generate choices congruent with patients’ and families’ values.

Here is an excerpt:

Decision Science in Ethics Practice

Clinical ethicists can support informed, value-congruent decision making in ethically complex clinical situations by working with stakeholders to identify and address biases and the kinds of barriers just discussed. Doing so requires constantly comparing actual decision-making processes with ideal decision-making processes, responding to information deficits, and integrating stakeholder values. One key step involves regularly urging clinicians to clarify both available options and possible outcomes and encouraging patients to consider both their values and the possible meanings of different outcomes.

Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?

Spiegel P, Kass N, Rubenstein L.
JAMA. Published online August 30, 2019.
doi:10.1001/jama.2019.12567

The modern successor to the Hippocratic oath, called the Declaration of Geneva, was updated and approved by the World Medical Association in 2017. The pledge states that “The health and well-being of my patient will be my first consideration” and “I will not use my medical knowledge to violate human rights and civil liberties, even under threat.” Can a physician work in US immigration detention facilities while upholding this pledge?

There is a humanitarian emergency at the US-Mexico border where migrants, including families, adults, or unaccompanied children, are detained and processed by the Department of Homeland Security’s (DHS) Customs and Border Patrol and are held in overcrowded and unsanitary conditions with insufficient medical care.2 Children (persons <18 years), without their parents or guardians, are often being detained in these detention facilities beyond the 72 hours allowed under federal law. Adults and children with a parent or legal guardian are then transferred from Customs and Border Patrol facilities to DHS’ Immigration and Customs Enforcement facilities, which are also overcrowded and where existing standards for conditions of confinement are often not met. Unaccompanied minors are transferred from Customs and Border Patrol detention facilities to Health and Human Services (HHS) facilities run by the Office of Refugee Resettlement (ORR). The majority of these unaccompanied children are then released to the care of community sponsors, while others stay, sometimes for months.

Children should not be detained for immigration reasons at all, according to numerous professional associations, including the American Academy of Pediatrics.3 Detention of children has been associated with increased physical and psychological illness, including posttraumatic stress disorder, as well as developmental delay and subsequent problems in school.

Given the psychological and physical harm to children who are detained, the United Nations Committee on the Rights of the Child stated that the detention of a child “cannot be justified solely on the basis of the child being unaccompanied or separated, or on their migratory or residence status, or lack thereof,” and should in any event only be used “…as a measure of last resort and for the shortest appropriate period of time.”6 The United States is the only country not to have ratified the convention on the Rights of the Child, but the international standard is so widely recognized that it should still apply. Children held in immigration detention should be released into settings where they are safe, protected, and can thrive.

The info is here.

Physicians Talking With Their Partners About Patients

Morris NP, & Eshel N.
JAMA. Published online August 16, 2019.
doi:10.1001/jama.2019.12293

Maintaining patient privacy is a fundamental responsibility for physicians. However, physicians often share their lives with partners or spouses. A 2018 survey of 15 069 physicians found that 85% were currently married or living with a partner, and when physicians come home from work, their partners might reasonably ask about their day. Physicians are supposed to keep patient information private in almost all circumstances, but are these realistic expectations for physicians and their partners? Might this expectation preclude potential benefits of these conversations?

In many cases, physician disclosure of clinical information to partners may violate patients’ trust. Patient privacy is so integral to the physician role that the Hippocratic oath notes, “And whatsoever I shall see or hear in the course of my profession...if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.” Whether over routine health care matters, such as blood pressure measurements; or potentially sensitive topics, such as end-of-life decisions, concerns of abuse, or substance use, patients expect their interactions with physicians to be kept in the strictest confidence. No hospital or clinic provides patients with the disclaimer, “Your private health information may be shared over the dinner table.” If a patient learned that his physician shared information about his medical encounters without permission, the patient may be far less likely to trust the physician or participate in ongoing care.

Physicians who share details with their partners about patients may not anticipate the effects of doing so. For instance, a physician’s partner could recognize the patient being discussed, whether from social connections or media coverage. After sharing patient information, physicians lose control of this information, and their partners, who may have less training about medical privacy, could unintentionally reveal sensitive patient information during future conversations.

The info is here.

Psychologist Found Guilty of Sexual Assault During Psychotherapy

Richard Bammer
www.mercurynews.com
Originally published July 27, 2019

A Solano County Superior Court judge on Friday sentenced to more than 11 years behind bars a former Travis Air Force Base psychologist found guilty last fall of a series of felony sexual assaults on female patients and three misdemeanor counts.

After hearing victim impact testimony and statements from attorneys — but before pronouncing the prison term — Judge E. Bradley Nelson looked directly at Heath Jacob Sommer, 43, saying he took a version of exposure therapy “to a new level” and used his “position of trust” between 2014 and 2016 to repeatedly take advantage of “very vulnerable people,” female patients who sought his help to cope with previous sexual trauma while on active duty.

And following a statement from Sommer — “I apologize … I never intended to be offensive to people,” he said — Nelson enumerated the counts, noting the second one, rape, would account for the greatest number of years, eight, in state prison, with two other felonies, oral copulation by fraudulent representation and sexual battery by fraudulent means, filling out the balance.

Nelson added 18 months in Solano County Jail for three misdemeanor charges of sexual battery for the purpose of sexual arousal. He then credited Sommer, shackled at the waist in a striped jail jumpsuit and displaying no visible reaction to the sentence, with 904 days in custody. Additionally, Sommer will be required to serve 20 years probation upon release, register as a sex offender for life, and pay nearly $10,000 in restitution to the victims and other court costs.

The info is here.

Medical Acts and Conscientious Objection: What Can a Physician be Compelled to Do?

Nathan K. Gamble and Michael Pruski

The New Bioethics
DOI: 10.1080/20502877.2019.1649871

Abstract

A key question has been underexplored in the literature on conscientious objection: if a physician is required to perform ‘medical activities,’ what is a medical activity? This paper explores the question by employing a teleological evaluation of medicine and examining the analogy of military conscripts, commonly cited in the conscientious objection debate. It argues that physicians (and other healthcare professionals) can only be expected to perform and support medical acts – acts directed towards their patients’ health. That is, physicians cannot be forced to provide or support services that are not medical in nature, even if such activities support other socially desirable pursuits. This does not necessarily mean that medical professionals cannot or should not provide non-medical services, but only that they are under no obligation to provide them.

Taking Ethics Seriously: Toward Comprehensive Education in Ethics and Human Rights for Psychologists

Duška Franeta
European Psychologist (2019), 24, pp. 125-135.

Education in ethics and professional regulation are not alternatives; education in ethics for psychologists should not be framed merely as instruction regarding current professional regulation, or “ethical training.” This would reduce ethics to essentially a legal perspective, diminish professional responsibility, debase professional ethics, and downplay its primary purpose – the continuous critical reflection of professional identity and professional role. This paper discusses the meaning and function of education in ethics for psychologists and articulates the reasons why comprehensive education in ethics for psychologists should not be substituted by instruction in professional codes. Likewise, human rights education for psychologists should not be downgraded to mere instruction in existing legal norms. Human rights discourse represents an important segment of the comprehensive education in ethics for psychologists. Education in ethics should expose and examine substantial ethical ideas that serve as the framework for the law of human rights as well as the interpretative, multifaceted, evolving, even manipulable character of the human rights narrative. The typically proclaimed duty of psychologists to protect and promote human rights requires a deepening and expounding of the human rights legal framework through elaborate scrutiny of its ethical meaning. The idea of affirming and restoring human dignity – the concept often designated as the legal and ethical basis, essence, and purpose of human rights – represents one approach to framing this duty by which the goals of psychology on the professional and ethical levels become unified.

The info is here.

The Business of Health Care Depends on Exploiting Doctors and Nurses

Danielle Ofri
The New York Times
Originally published June 8, 2019

One resource seems infinite and free: the professionalism of caregivers.

You are at your daughter’s recital and you get a call that your elderly patient’s son needs to talk to you urgently.  A colleague has a family emergency and the hospital needs you to work a double shift.  Your patient’s M.R.I. isn’t covered and the only option is for you to call the insurance company and argue it out.  You’re only allotted 15 minutes for a visit, but your patient’s medical needs require 45.

These quandaries are standard issue for doctors and nurses.  Luckily, the response is usually standard issue as well: An overwhelming majority do the right thing for their patients, even at a high personal cost.

It is true that health care has become corporatized to an almost unrecognizable degree.  But it is also true that most clinicians remain committed to the ethics that brought them into the field in the first place.  This makes the hospital an inspiring place to work.

Increasingly, though, I’ve come to the uncomfortable realization that this ethic that I hold so dear is being cynically manipulated.

By now, corporate medicine has milked just about all the “efficiency” it can out of the system.  With mergers and streamlining, it has pushed the productivity numbers about as far as they can go.

But one resource that seems endless — and free — is the professional ethic of medical staff members.

This ethic holds the entire enterprise together.  If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous.  Doctors and nurses know this, which is why they don’t shirk.  The system knows it, too, and takes advantage.

The demands on medical professionals have escalated relentlessly in the past few decades, without a commensurate expansion of time and resources.  For starters, patients are sicker these days.  The medical complexity per patient — the number and severity of chronic conditions — has steadily increased, meaning that medical encounters are becoming ever more involved.  They typically include more illnesses to treat, more medications to administer, more complications to handle — all in the same-length office or hospital visit.

The information is here.

From the talking cure to a disease of silence: Effects of ethical violations in a psychoanalytic institute

Jane Burka, Angela Sowa, Barbara A. Baer, & others
The International Journal of Psychoanalysis (2019) 100:2, 247-271,

Abstract

This article presents an in-depth study of one institute’s efforts to recover from effects of ethical violations by two senior members. Qualitative data analysis from voluntary member interviews details the damage that spread throughout the institute, demonstrating that a violation of one is a violation of many. Members at all levels reported feeling disturbed in ways that affected their emotional equilibrium, their thinking processes, and their social and professional relationships. The aggregated interview data were reported to the institute community in large and small group meetings designed to reverse the “disease of silence” and to allow members to talk with each other. Outside consultation helped with this emotionally arduous process. The authors offer hypotheses concerning the nature of group anxieties during ethics crises. We assert that both sexual and non-sexual boundary violations break the incest taboo, as they breach the generational protection required of professional interactions. Ethical violations attack the group’s foundational ethos of care, unleashing primitive anxieties and defences that interfere with capacities for thinking, containment, collaboration, and integration. Since the full reality of what happened is unknowable, hybrid truths emerge, causing conflict and disturbances that inhibit thoughtful group discourse.

The article can be downloaded here.

Why “happy” doctors die by suicide

Pamela Wible
www.idealmedicalcare.org
Originally posted on August 24, 2018

Here is an excerpt:

Doctor suicides on the registry were submitted to me during a six-year period (2012-2018) by families, friends, and colleagues who knew the deceased. After speaking to thousands of suicidal physicians since 2012 on my informal doctor suicide hotline and analyzing registry data, I discovered surprising themes—many unique to physicians.

Public perception maintains that doctors are successful, intelligent, wealthy, and immune from the problems of the masses. To patients, it is inconceivable that doctors would have the highest suicide rate of any profession (5).

Even more baffling, “happy” doctors are dying by suicide. Many doctors who kill themselves appear to be the most optimistic, upbeat, and confident people. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs up to the team after a successful surgery—and hours later they shoot themselves in the head.

Doctors are masters of disguise and compartmentalization.

Turns out some of the happiest people—especially those who spend their days making other people happy—may be masking their own despair.

The info is here.

Law, Ethics, and Conversations between Physicians and Patients about Firearms in the Home

Alexander D. McCourt, and Jon S. Vernick
AMA J Ethics. 2018;20(1):69-76.

Abstract

Firearms in the home pose a risk to household members, including homicide, suicide, and unintentional deaths. Medical societies urge clinicians to counsel patients about those risks as part of sound medical practice. Depending on the circumstances, clinicians might recommend safe firearm storage, temporary removal of the firearm from the home, or other measures. Certain state firearm laws, however, might present legal and ethical challenges for physicians who counsel patients about guns in the home. Specifically, we discuss state background check laws for gun transfers, safe gun storage laws, and laws forbidding physicians from engaging in certain firearm-related conversations with their patients. Medical professionals should be aware of these and other state gun laws but should offer anticipatory guidance when clinically appropriate.

The info is here.

How Should Clinicians Respond to Requests from Patients to Participate in Prayer?

A. R. Christensen, T. E. Cook, and R. M. Arnold
AMA J Ethics. 2018;20(7):E621-629.

Abstract

Over the past 20 years, physicians have shifted from viewing a patient’s request for prayer as a violation of professional boundaries to a question deserving nuanced understanding of the patient’s needs and the clinician’s boundaries. In this case, Mrs. C’s request for prayer can reflect religious distress, anxiety about her clinical circumstances, or a desire to better connect with her physician. These different needs suggest that it is important to understand the request before responding. To do this well requires that Dr. Q not be emotionally overwhelmed by the request and that she has skill in discerning potential reasons for the request.

The info is here.

Druggists Shouldn't Act as Morality Police

The Editors
Scientific American
Originally published July 18, 2018

Here is an excerpt:

In states with conscience carve-outs for pharmacists, pharmacies honoring those policies should be required to preemptively notify state authorities and medical providers that they might refuse service.

That way, women and their doctors could make alternative arrangements to fill prescriptions at pharmacies that will give them the medications they need —avoiding situations like the recent one in Arizona. (This follows a model worked out in 2014, when the Supreme Court told the Obama administration that employers with moral objections did not have to offer an insurance plan with birth control coverage. But such employers did have to notify the Department of Health and Human Services so the government and insurers could provide birth control coverage via a private insurance plan or a government-sponsored one.)

And in situations where individual pharmacists may refuse service—even if their pharmacies generally fill family-planning prescriptions—there should be a legal requirement to automatically refer that prescription to another pharmacy within a certain reasonable distance or to have a backup pharmacist on call to do the work so that patients can get medications quickly and efficiently.

The information is here.

The Case of Dr. Oz: Ethics, Evidence, and Does Professional Self-Regulation Work?

Jon Tilburt, Megan Allyse, and Frederic 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 information is here.

The Revised Declaration of Geneva

Ramin Walter Parsa-Parsi
JAMA. 2017;318(20):1971-1972.

Here is an excerpt:

The most notable difference between the Declaration of Geneva and other key ethical documents, such as the WMA’s Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects and the Declaration of Taipei on Ethical Considerations Regarding Health Databases and Biobanks, was determined to be the lack of overt recognition of patient autonomy, despite references to the physician’s obligation to exercise respect, beneficence, and medical confidentiality toward his or her patient(s). To address this difference, the workgroup, informed by other WMA members, ethical advisors, and other experts, recommended adding the following clause: “I WILL RESPECT the autonomy and dignity of my patient.” In addition, to highlight the importance of patient self-determination as one of the key cornerstones of medical ethics, the workgroup also recommended shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations.

To more explicitly invoke the standards of ethical and professional conduct expected of physicians by their patients and peers, the clause “I WILL PRACTISE my profession with conscience and dignity” was augmented to include the wording “and in accordance with good medical practice.”

The article and the Declaration can be found here.